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Bosch-Capblanch X, Esu E, Oringanje CM, Dongus S, Jalilian H, Eyers J, Auer C, Meremikwu M, Röösli M. The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A systematic review of human experimental studies. Environ Int 2024; 187:108612. [PMID: 38640611 DOI: 10.1016/j.envint.2024.108612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s exposing large proportions of the population. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF. OBJECTIVES To systematically assess the effects of exposure to RF-EMF on self-reported non-specific symptoms in human subjects and to assess the accuracy of perceptions of presence or absence of RF-EMF exposure. METHODS Eligibility criteria: experimental studies carried out in the general population and in individuals with idiopathic environmental intolerance attributed to EMF (IEI-EMF), in any language. INFORMATION SOURCES Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos, Embase and EMF portal, searched till April 2022. Risk of Bias (ROB): we used the RoB tool developed by OHAT adapted to the topic of this review. SYNTHESIS OF RESULTS we synthesized studies using random effects meta-analysis and sensitivity analyses, where appropriate. RESULTS Included studies: 41 studies were included, mostly cross over trials and from Europe, with a total of 2,874 participants. SYNTHESIS OF RESULTS considering the primary outcomes, we carried out meta-analyses of 10 exposure-outcomes pairs. All evidence suggested no or small non-significant effects of exposure on symptoms with high (three comparisons), moderate (four comparisons), low (one comparison) and very low (two comparisons) certainty of evidence. The effects (standard mean difference, where positive values indicate presence of symptom being exposed) in the general population for head exposure were (95% confidence intervals) 0.08 (-0.07 to 0.22) for headache, -0.01 (-0.22 to 0.20) for sleeping disturbances and 0.13 (-0.51 to 0.76) for composite symptoms; and for whole-body exposure: 0.09 (-0.35 to 0.54), 0.00 (-0.15 to 0.15) for sleeping disturbances and -0.05 (-0.17 to 0.07) for composite symptoms. For IEI-EMF individuals SMD ranged from -0.19 to 0.11, all of them with confidence intervals crossing the value of zero. Further, the available evidence suggested that study volunteers could not perceive the EMF exposure status better than what is expected by chance and that IEI-EMF individuals could not determine EMF conditions better than the general population. DISCUSSION Limitations of evidence: experimental conditions are substantially different from real-life situations in the duration, frequency, distance and position of the exposure. Most studies were conducted in young, healthy volunteers, who might be more resilient to RF-EMF than the general population. The outcomes of interest in this systematic review were symptoms, which are self-reported. The available information did not allow to assess the potential effects of exposures beyond acute exposure and in elderly or in chronically ill people. It cannot be ruled out that a real EMF effect in IEI-EMF groups is masked by a mix with insensitive subjects. However, studies on symptoms reporting and/or field perceptions did not find any evidence that there were particularly vulnerable individuals in the IEI-EMF group, although in open provocation studies, when volunteers were informed about the presence or absence of EMF exposure, such differences were consistently observed. INTERPRETATION available evidence suggests that acute RF-EMF below regulatory limits does not cause symptoms and corresponding claims in the everyday life are related to perceived and not to real EMF exposure status.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH 45247, USA.
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Hamed Jalilian
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - John Eyers
- Independent Consultant & Senior Research Fellow, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, United Kingdom.
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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Röösli M, Dongus S, Jalilian H, Eyers J, Esu E, Oringanje CM, Meremikwu M, Bosch-Capblanch X. The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A systematic review and meta-analysis on human observational studies. Environ Int 2024; 183:108338. [PMID: 38104437 DOI: 10.1016/j.envint.2023.108338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/01/2023] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters). OBJECTIVES The objective is to systematically review the effects of longer-term or repeated local and whole human body radiofrequency electromagnetic field (RF-EMF) exposure on the occurrence of symptoms. Primary hypotheses were tinnitus, migraine and headaches in relation to RF-EMF exposure of the brain, sleep disturbances and composite symptom scores in relation to whole-body RF-EMF exposure. METHODS Eligibility criteria: We included case-control and prospective cohort studies in the general population or workers estimating local or whole-body RF-EMF exposure for at least one week. INFORMATION SOURCES We conducted a systematic literature search in various databases including Web of Science and Medline. Risk of bias: We used the Risk of Bias (RoB) tool developed by OHAT adapted to the topic of this review. SYNTHESIS OF RESULTS We synthesized studies using random effects meta-analysis. RESULTS Included studies: We included 13 papers from eight distinct cohort and one case-control studies with a total of 486,558 participants conducted exclusively in Europe. Tinnitus is addressed in three papers, migraine in one, headaches in six, sleep disturbances in five, and composite symptom scores in five papers. Only one study addressed occupational exposure. SYNTHESIS OF RESULTS For all five priority hypotheses, available research suggests that RF-EMF exposure below guideline values does not cause symptoms, but the evidence is very uncertain. The very low certainty evidence is due the low number of studies, possible risk of bias in some studies, inconsistencies, indirectness, and imprecision. In terms of non-priority hypotheses numerous exposure-outcome combinations were addressed in the 13 eligible papers without indication for an association related to a specific symptom or exposure source. DISCUSSION Limitations of evidence: This review topic includes various challenges related to confounding control and exposure assessment. Many of these aspects are inherently present and not easy to be solved in future research. Since near-field exposure from wireless communication devices is related to lifestyle, a particular challenge is to differentiate between potential biophysical effects and other potential effects from extensive use of wireless communication devices that may compete with healthy behaviour such as sleeping or physical activity. Future research needs novel and innovative methods to differentiate between these two hypothetical mechanisms. INTERPRETATION This is currently the best available evidence to underpin safety of RF-EMF. There is no indication that RF-EMF below guideline values causes symptoms. However, inherent limitations of the research results in substantial uncertainty. OTHER Funding: This review was partially funded by the WHO radioprotection programme. REGISTRATION The protocol for this review has been registered in Prospero (reg no CRD42021239432) and published in Environment International (Röösli et al., 2021).
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Affiliation(s)
- Martin Röösli
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Hamed Jalilian
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - John Eyers
- International Initiative for Impact Evaluation, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, UK
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH, USA
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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Shayegh S, Andreu-Perez J, Akoth C, Bosch-Capblanch X, Dasgupta S, Falchetta G, Gregson S, Hammad AT, Herringer M, Kapkea F, Labella A, Lisciotto L, Martínez L, Macharia PM, Morales-Ruiz P, Murage N, Offeddu V, South A, Torbica A, Trentini F, Melegaro A. Prioritizing COVID-19 vaccine allocation in resource poor settings: Towards an Artificial Intelligence-enabled and Geospatial-assisted decision support framework. PLoS One 2023; 18:e0275037. [PMID: 37561732 PMCID: PMC10414619 DOI: 10.1371/journal.pone.0275037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVES To propose a novel framework for COVID-19 vaccine allocation based on three components of Vulnerability, Vaccination, and Values (3Vs). METHODS A combination of geospatial data analysis and artificial intelligence methods for evaluating vulnerability factors at the local level and allocate vaccines according to a dynamic mechanism for updating vulnerability and vaccine uptake. RESULTS A novel approach is introduced including (I) Vulnerability data collection (including country-specific data on demographic, socioeconomic, epidemiological, healthcare, and environmental factors), (II) Vaccination prioritization through estimation of a unique Vulnerability Index composed of a range of factors selected and weighed through an Artificial Intelligence (AI-enabled) expert elicitation survey and scientific literature screening, and (III) Values consideration by identification of the most effective GIS-assisted allocation of vaccines at the local level, considering context-specific constraints and objectives. CONCLUSIONS We showcase the performance of the 3Vs strategy by comparing it to the actual vaccination rollout in Kenya. We show that under the current strategy, socially vulnerable individuals comprise only 45% of all vaccinated people in Kenya while if the 3Vs strategy was implemented, this group would be the first to receive vaccines.
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Affiliation(s)
- Soheil Shayegh
- RFF-CMCC European Institute on Economics and the Environment, Centro Euro-Mediterraneo sui Cambiamenti Climatici, Milan, Italy
| | - Javier Andreu-Perez
- Centre for Computational Intelligence, School of Computer Science and Electronic Engineering, University of Essex, Colchester, United Kingdom
- Group Simbad, Department of Computer Science, University of Jaén, Jaén, Spain
| | | | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Shouro Dasgupta
- Fondazione CMCC, Lecce, Italy
- Ca’ Foscari University of Venice, Venice, Italy
| | - Giacomo Falchetta
- RFF-CMCC European Institute on Economics and the Environment, Centro Euro-Mediterraneo sui Cambiamenti Climatici, Milan, Italy
- International Institute for Applied Systems Analysis, Vienna, Austria
| | - Simon Gregson
- Imperial College School of Public Health, Imperial College London, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ahmed T. Hammad
- Università Cattolica del Sacro Cuore, Milan, Italy
- Decatab Pte. Ltd., Singapore, Singapore
| | - Mark Herringer
- The Global Healthsites Mapping Project—Healthsites.io, Hoorn, Netherlands
- Mapping the Risk of International Infectious Disease Spread—mriids.org, Brookline, Massachusetts, United States of America
| | | | - Alvaro Labella
- Department of Computer Science, University of Jaén, Jaén, Spain
| | - Luca Lisciotto
- Ca’ Foscari University of Venice, Venice, Italy
- DNV—Energy Systems, Bologna, Italy
| | - Luis Martínez
- Department of Computer Science, University of Jaén, Jaén, Spain
| | - Peter M. Macharia
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
- Population & Health Impact Surveillance GroupUnit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Paulina Morales-Ruiz
- Faculty of Economics and Business, Access-to-Medicines Research Centre, Research Center for Operations Management, KU Leuven, Leuven, Belgium
| | | | - Vittoria Offeddu
- Covid Crisis Lab, Bocconi University, Milan, Italy
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Andy South
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Aleksandra Torbica
- Cergas—Centre for Research on Health and Social Csare Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy
- Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Filippo Trentini
- Covid Crisis Lab, Bocconi University, Milan, Italy
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
- Center for Health Emergencies, Bruno Kessler Foundation, Povo, Italy
| | - Alessia Melegaro
- Covid Crisis Lab, Bocconi University, Milan, Italy
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
- Department of Social and Political Science, Bocconi University, Milan, Italy
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Ekpenyong N, Heitz Tokpa K, Nwankwo O, O'Donnell D, Rodriguez Franco D, Berté S, Amani Kouassi S, Eteng G, Undelikwo V, Auer C, Guessan Bi GB, Oyo-Ita A, Bosch-Capblanch X. Using and improving the PHISICC paper-based tools in the health facility laboratories: Examples of Human Centered Design taking systems thinking into practice, in Côte d'Ivoire and Nigeria. Front Public Health 2022; 10:916397. [PMID: 36187697 PMCID: PMC9521270 DOI: 10.3389/fpubh.2022.916397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/28/2022] [Indexed: 01/22/2023] Open
Abstract
Background Health workers in low- and middle-income countries are increasingly demanded to collect more and more data to report them to higher levels of the health information system (HIS), in detriment of useful data for clinical and public health decision-making, potentially compromising the quality of their health care provison. In order to support health workers' decision-making, we engaged with partners in Côte d'Ivoire, Mozambique and Nigeria in a research project to conceive, design, produce, implement and test paper-based health information tools: the PHISICC tools. Our aim was to understand the use of PHISICC tools by health workers and to improve them based on their feedback. Methods The design Health Facility Laboratories (HF Labs) in Côte d'Ivoire and in Nigeria were set up after months of use of PHISICC tools. Activities were structured in three phases or 'sprints' of co-creative research. We used a transdisciplinary approach, including anthropology and Human Centered Design (HCD), observations, shadowing, structured interviews and co-creation. Results Health workers appreciated the standardization of the tools across different health care areas, with a common visual language that optimized use. Several design issues were raised, in terms of formats and contents. They strongly appreciated how the PHISICC registers guided their clinical decision-making and how it facilitated tallying and counting for monthly reporting. However, adherence to new procedures was not universal. The co-creation sessions resulted in modifications to the PHISICC tools of out-patient care and postnatal care. Discussion Although health systems and systemic thinking allowed the teams to embrace complexity, it was the HCD approach that actually produced a shift in researchers' mind-set: from HIS as data management tools to HIS as quality of care instruments. HCD allowed navigating the complexity of health systems interventions due to its capacity to operate change: it not only allowed us to understand how the PHISICC tools were used but also how to further improve them. In the absence of (or even with) an analytical health systems framework, HCD approaches can work in real-life situations for the ideation, testing and implementation of interventions to improve health systems and health status outcomes.
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Affiliation(s)
- Nnette Ekpenyong
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Kathrin Heitz Tokpa
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire,University of Basel, Basel, Switzerland
| | - Ogonna Nwankwo
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria,University of Basel, Basel, Switzerland,Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | | | - Salimata Berté
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire,Ecological Research Center, University of Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Simplice Amani Kouassi
- Ministry of Health and Public Hygiene, Directorate General of Health, Abidjan, Côte d'Ivoire
| | - Glory Eteng
- Department of Social Work, University of Calabar, Calabar, Nigeria
| | | | - Christian Auer
- University of Basel, Basel, Switzerland,Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | - Angela Oyo-Ita
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Xavier Bosch-Capblanch
- University of Basel, Basel, Switzerland,Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland,*Correspondence: Xavier Bosch-Capblanch
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Jalilian H, Dongus S, Bosch-Capblanch X, Röösli M. Letter to the Editor "Mobile phone electromagnetic radiation and the risk of headache: a systematic review and meta‑analysis". Int Arch Occup Environ Health 2022; 95:1913-1914. [PMID: 35639153 DOI: 10.1007/s00420-022-01890-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Hamed Jalilian
- Department of Occupational Health Engineering, Research Center for Environmental Pollutants, Faculty of Health, Qom University of Medical Sciences, Qom, Iran.
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland.,University of Basel, Petersplatz 1, CH-4003, Basel, Switzerland
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland.,University of Basel, Petersplatz 1, CH-4003, Basel, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland.,University of Basel, Petersplatz 1, CH-4003, Basel, Switzerland
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Bosch-Capblanch X, Esu E, Dongus S, Oringanje CM, Jalilian H, Eyers J, Oftedal G, Meremikwu M, Röösli M. The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A protocol for a systematic review of human experimental studies. Environ Int 2022; 158:106953. [PMID: 34735955 PMCID: PMC8668868 DOI: 10.1016/j.envint.2021.106953] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/13/2021] [Accepted: 10/21/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s across multiple sectors exposing large proportions of the population. This fact has raised concerns related to the potential consequences to people's health. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF and has carried out an international survey amongst experts, who have identified six priority topics to be further addressed through systematic reviews, whereof the effects on symptoms is one of them. We report here the systematic review protocol of experimental studies in humans assessing the effects of RF-EMF on symptoms. OBJECTIVE Our objectives are to assess the effects of exposure to electromagnetic fields (compared to no or lower exposure levels) on symptoms in human subjects. We will also assess the accuracy of perception of presence of exposure in volunteers with and without idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). ELIGIBILITY CRITERIA We will search relevant literature sources (e.g. the Web of Science, Medline, Embase, Epistemonikos) for randomized trials (comparing at least two arms) and randomised crossover trials of RF-EMF exposure that have assessed the effects on symptoms. We will also include studies that have measured the accuracy of the perception of the presence or absence of exposure. We will include studies in any language. STUDY APPRAISAL AND SYNTHESIS Studies will be assessed against inclusion criteria by two independent reviewers. Data on study characteristics, participants, exposure, comparators and effects will be extracted using a specific template for this review, by two independent reviewers. Discrepancies will be solved by consensus. Risk of bias (ROB) will be assessed using the ROB Rating Tool for Human and Animal Studies and the level of confidence in the evidence of the exposure-outcome relations will be assessed using the GRADE approach. For the perception studies, we will use adapted versions of the ROB tool and GRADE assessment. Where appropriate, data will be combined using meta-analytical techniques.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH 45247, United States
| | - Hamed Jalilian
- Department of Occupational Health Engineering, Research Center for Environmental Pollutants, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - John Eyers
- Independent Consultant & Senior Research Fellow, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, UK
| | - Gunnhild Oftedal
- Department of Electronic Systems, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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Röösli M, Dongus S, Jalilian H, Feychting M, Eyers J, Esu E, Oringanje CM, Meremikwu M, Bosch-Capblanch X. The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A protocol for a systematic review on human observational studies. Environ Int 2021; 157:106852. [PMID: 34500362 PMCID: PMC8484767 DOI: 10.1016/j.envint.2021.106852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters). Concern has been raised that RF-EMF exposure affects health related quality of life, because a part of the population reports to experience a variety of symptoms related to low exposure levels below regulatory limits. OBJECTIVES To systematically review the effects of longer-term or repeated local and whole human body RF-EMF exposure on the occurrence of symptoms evaluating migraine, tinnitus, headaches, sleep disturbances and composite symptom scores as primary outcomes. METHODS We will follow the WHO handbook for guideline development. For the development of the systematic review protocol we considered handbook for conducting systematic reviews for health effects evaluations from the National Toxicology Program-Office of Health Assessment and Translation (NTP-OHAT) and COSTER (Recommendations for the conduct of systematic reviews in toxicology and environmental health research). ELIGIBILITY CRITERIA Peer-reviewed epidemiological studies in the general population or workers aiming to investigate the association between local or whole-body RF-EMF exposure for at least one week and symptoms are eligible for inclusion. Only cohort, case-control and panel studies will be included. INFORMATION SOURCES We will search the scientific literature databases Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos and Embase, using a predefined search strategy. This search will be supplemented by a search in the EMF-Portal and checks of reference lists of relevant papers and reviews. STUDY APPRAISAL AND SYNTHESIS METHOD Data from included papers will be extracted according to predefined forms. Findings will be summarized in tables, graphical displays and in a narrative synthesis of the available evidence, complemented with meta-analyses. We will separately review effects of local, far field and occupational exposure. RISK OF BIAS The internal validity of included studies will be assessed using the NTP-OHAT Risk of Bias Rating Tool for Human and Animal Studies, elaborated to observational RF-EMF studies. EVIDENCE APPRAISAL To rate certainty of the evidence, we will use the OHAT GRADE-based approach for epidemiological studies. FRAMEWORK AND FUNDING This protocol concerns one of the ten different systematic reviews considered in a larger systematic review of the World Health Organization to assess potential health effects of exposure to RF-EMF in the general and working population. REGISTRATION PROSPERO CRD42021239432.
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Affiliation(s)
- Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Hamed Jalilian
- Department of Occupational Health Engineering, Research Center for Environmental Pollutants, Faculty of Health, Qom University of Medical Sciences, Qom, Iran.
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - John Eyers
- International Initiative for Impact Evaluation, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, United Kingdom.
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH, USA.
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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Oyo-Ita AE, Hanlon P, Nwankwo O, Bosch-Capblanch X, Arikpo D, Esu E, Auer C, Meremikwu M. Cost-effectiveness analysis of an intervention project engaging Traditional and Religious Leaders to improve uptake of childhood immunization in southern Nigeria. PLoS One 2021; 16:e0257277. [PMID: 34529714 PMCID: PMC8445457 DOI: 10.1371/journal.pone.0257277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
Vaccination is a cost-effective public health intervention, yet evidence abounds that vaccination uptake is still poor in many low- and middle-income countries. Traditional and Religious Leaders play a substantial role in improving the uptake of health services such as immunization. However, there is paucity of evidence on the cost-effectiveness of using such strategies. This study aimed to assess the cost-effectiveness of using a multi-faceted intervention that included traditional and religious leaders for community engagement to improve uptake of routine immunisation services in communities in Cross River State, Southern Nigeria. The target population for the intervention was traditional and religious leaders in randomly selected communities in Cross River State. The impact of the intervention on the uptake of routine vaccination among children 0 to 23 months was assessed using a cluster randomized trials. Outcome assessments were performed at the end of the project (36 months).The cost of the intervention was obtained from the accounting records for expenditures incurred in the course of implementing the intervention. Costs were assessed from the health provider perspective. The cost-effectiveness analysis showed that the incremental cost of the initial implementation of the intervention was US$19,357and that the incremental effect was 323 measles cases averted, resulting in an incremental cost-effectiveness ratio (ICER) of US$60/measles case averted. However, for subsequent scale-up of the interventions to new areas not requiring a repeat expenditure of some of the initial capital expenditure the ICER was estimated to be US$34 per measles case averted. Involving the traditional and religious leaders in vaccination is a cost-effective strategy for improving the uptake of childhood routine vaccinations.
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Affiliation(s)
- Angela E. Oyo-Ita
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- * E-mail:
| | - Patrick Hanlon
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ogonna Nwankwo
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Dachi Arikpo
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ekperonne Esu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Martin Meremikwu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Paediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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Bosch-Capblanch X, O'Donnell D, Krause LK, Auer C, Oyo-Ita A, Samba M, Matsinhe G, Garba AB, Rodríguez D, Zuske M, Njepuome AN, Lee SMM, Ross A, Gajewski S, Muloliwa AM, Yapi RB, Brown DW. Researching, co-creating and testing innovations in paper-based health information systems (PHISICC) to support health workers' decision-making: protocol of a multi-country, transdisciplinary, mixed-methods research programme in three sub-Saharan countries. Health Res Policy Syst 2021; 19:112. [PMID: 34380518 PMCID: PMC8355573 DOI: 10.1186/s12961-021-00768-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/30/2021] [Indexed: 12/19/2022] Open
Abstract
Background Health information systems are crucial to provide data for decision-making and demand for data is constantly growing. However, the link between data and decisions is not always rational or linear and the management of data ends up overloading frontline health workers, which may compromise quality of healthcare delivery. Despite limited evidence, there is an increasing push for the digitalization of health information systems, which poses enormous challenges, particularly in remote, rural settings in low- and middle-income countries. Paper-based tools will continue to be used in combination with digital solutions and this calls for efforts to make them more responsive to local needs. Paper-based Health Information Systems in Comprehensive Care (PHISICC) is a transdisciplinary, multi-country research initiative to create and test innovative paper-based health information systems in three sub-Saharan African countries. Methods/Design The PHISICC initiative is being carried out in remote, rural settings in Côte d’Ivoire, Mozambique and Nigeria through partnership with ministries of health and research institutions. We began with research syntheses to acquire the most up-to-date knowledge on health information systems. These were coupled with fieldwork in the three countries to understand the current design, patterns and contexts of use, and healthcare worker perspectives. Frontline health workers, with designers and researchers, used co-creation methods to produce the new PHISICC tools. This suite of tools is being tested in the three countries in three cluster-randomized controlled trials. Throughout the project, we have engaged with a wide range of stakeholders and have maintained the highest scientific standards to ensure that results are relevant to the realities in the three countries. Discussion We have deployed a comprehensive research approach to ensure the robustness and future policy uptake of findings. Besides the innovative PHISICC paper-based tools, our process is in itself innovative. Rather than emphasizing the technical dimensions of data management, we focused instead on frontline health workers’ data use and decision-making. By tackling the whole scope of primary healthcare areas rather than a subset of them, we have developed an entirely new design and visual language for a suite of tools across healthcare areas. The initiative is being tested in remote, rural areas where the most vulnerable live.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | | | - L Kendall Krause
- Bill & Melinda Gates Foundation, Seattle, WA, United States of America
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Angela Oyo-Ita
- Department of Community Medicine, University of Calabar, Calabar, Nigeria
| | - Mamadou Samba
- Ministère de La Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire.,Université Félix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | - Graça Matsinhe
- Expanded Program on Immunization, Ministry of Health, Maputo, Mozambique
| | - Abdullahi Bulama Garba
- Director Planning, Research and Statistics, National Primary Health Care Development Agency, Abuja, Nigeria
| | | | - Meike Zuske
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | | | - Amanda Ross
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Suzanne Gajewski
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Richard B Yapi
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Centre d'Entomologie Médicale et Vétérinaire, Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - David W Brown
- BCGI LLC / pivot-23.5°, Cornelius, NC, United States of America
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10
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Bosch-Capblanch X, Oyo-Ita A, Muloliwa AM, Yapi RB, Auer C, Samba M, Gajewski S, Ross A, Krause LK, Ekpenyong N, Nwankwo O, Njepuome AN, Lee SM, Sacarlal J, Madede T, Berté S, Matsinhe G, Garba AB, Brown DW. Does an innovative paper-based health information system (PHISICC) improve data quality and use in primary healthcare? Protocol of a multicountry, cluster randomised controlled trial in sub-Saharan African rural settings. BMJ Open 2021; 11:e051823. [PMID: 34326056 PMCID: PMC8323359 DOI: 10.1136/bmjopen-2021-051823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/07/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Front-line health workers in remote health facilities are the first contact of the formal health sector and are confronted with life-saving decisions. Health information systems (HIS) support the collection and use of health related data. However, HIS focus on reporting and are unfit to support decisions. Since data tools are paper-based in most primary healthcare settings, we have produced an innovative Paper-based Health Information System in Comprehensive Care (PHISICC) using a human-centred design approach. We are carrying out a cluster randomised controlled trial in three African countries to assess the effects of PHISICC compared with the current systems. METHODS AND ANALYSIS Study areas are in rural zones of Côte d'Ivoire, Mozambique and Nigeria. Seventy health facilities in each country have been randomly allocated to using PHISICC tools or to continuing to use the regular HIS tools. We have randomly selected households in the catchment areas of each health facility to collect outcomes' data (household surveys have been carried out in two of the three countries and the end-line data collection is planned for mid-2021). Primary outcomes include data quality and use, coverage of health services and health workers satisfaction; secondary outcomes are additional data quality and use parameters, childhood mortality and additional health workers and clients experience with the system. Just prior to the implementation of the trial, we had to relocate the study site in Mozambique due to unforeseen logistical issues. The effects of the intervention will be estimated using regression models and accounting for clustering using random effects. ETHICS AND DISSEMINATION Ethics committees in Côte d'Ivoire, Mozambique and Nigeria approved the trials. We plan to disseminate our findings, data and research materials among researchers and policy-makers. We aim at having our findings included in systematic reviews on health systems interventions and future guidance development on HIS. TRIAL REGISTRATION NUMBER PACTR201904664660639; Pre-results.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- University of Basel, Basel, Basel-Stadt, Switzerland
| | - Angela Oyo-Ita
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | | | - Richard B Yapi
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Lagunes, Côte d'Ivoire
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- University of Basel, Basel, Basel-Stadt, Switzerland
| | - Mamadou Samba
- Ministère de la Santé et de l'Hygiène Publique, Abidjan, Lagunes, Côte d'Ivoire
| | - Suzanne Gajewski
- Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- University of Basel, Basel, Basel-Stadt, Switzerland
| | - Amanda Ross
- Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- University of Basel, Basel, Basel-Stadt, Switzerland
| | | | - Nnette Ekpenyong
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Ogonna Nwankwo
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | | | | | - Jahit Sacarlal
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Tavares Madede
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Salimata Berté
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Lagunes, Côte d'Ivoire
| | - Graça Matsinhe
- Expanded Program on Immunization, Ministério da Saúde, Maputo, Mozambique
| | - Abdullahi Bulama Garba
- Planning, Research and Statistics, National Primary Healthcare Development Agency, Abuja, Nigeria
| | - David W Brown
- BCGI LLC / pivot-23.5°, Chapel Hill, North Carolina, USA
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11
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Oyo-Ita A, Bosch-Capblanch X, Ross A, Oku A, Esu E, Ameh S, Oduwole O, Arikpo D, Meremikwu M. Effects of engaging communities in decision-making and action through traditional and religious leaders on vaccination coverage in Cross River State, Nigeria: A cluster-randomised control trial. PLoS One 2021; 16:e0248236. [PMID: 33861742 PMCID: PMC8051768 DOI: 10.1371/journal.pone.0248236] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Vaccination coverage levels fall short of the Global Vaccine and Action Plan 90% target in low- and middle- income countries (LMICs). Having identified traditional and religious leaders (TRLs) as potential public health change agents, this study aimed at assessing the effect of training them to support routine immunisation for the purpose of improving uptake of childhood vaccines in Cross River State, Nigeria. Methods A cluster-randomised controlled study was conducted between 2016 and 2019. Of the 18 Local Government Areas (LGA) in Cross River State, eight (four urban and four rural LGAs) were randomized into the intervention and control study arms. A multi-component intervention involving the training of traditional and religious leaders was implemented in the four intervention LGAs. Baseline, midline and endline surveys collected information on children aged 0–23 months. The effect of the intervention on outcomes including the proportion fully up-to-date with vaccination, timely vaccination for pentavalent and measles vaccines, and pentavalent 1–3 dropout rates were estimated using logistic regression models using random effects to account for the clustered data. Results A total of 2598 children at baseline, 2570 at midline, and 2550 at endline were included. The intervention was effective in increasing the proportion with at least one vaccine (OR 12.13 95% CI 6.03–24.41p<0.001). However, there was no evidence of an impact on the proportion of children up-to-date with vaccination (p = 0.69). It was effective in improving timeliness of Pentavalent 3 (OR 1.55; 95% CI: 1.14, 2.12; p = 0.005) and Measles (OR 2.81; 96% CI: 1.93–4.1; p<0.001) vaccination. The odds of completing Pentavalent vaccination increased (OR = 1.66 95% CI: 1.08,2.55). Conclusion Informal training to enhance the traditional and religious leaders’ knowledge of vaccination and their leadership role can empower them to be good influencers for childhood vaccination. They constitute untapped resources in the community to boost routine immunisation. Pan African Clinical Trial Registry (PACTR) PACTR202008784222254.
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Affiliation(s)
- Angela Oyo-Ita
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
- * E-mail:
| | - Xavier Bosch-Capblanch
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Amanda Ross
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Afiong Oku
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Ekpereonne Esu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
- Department of Public Health, Faculty of Allied Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Soter Ameh
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Olabisi Oduwole
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
- Department of Medical Laboratory Science, Achievers University, Owo, Ondo State, Nigeria
| | - Dachi Arikpo
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Martin Meremikwu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
- Department of Paediatrics, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
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12
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Auer C, Mazitov R, Makhmudov A, Pirmahmadzoda B, Skrahina A, Dobre A, Sécula F, Bosch-Capblanch X, Van den Boom M, Migliori GB, Mdivani N, Yassin MA. Factors contributing to drug-resistant tuberculosis treatment outcome in five countries in the Eastern Europe and Central Asia region. Monaldi Arch Chest Dis 2020; 90. [PMID: 32231347 DOI: 10.4081/monaldi.2020.1235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/11/2020] [Indexed: 11/22/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) is a global challenge and a major contributor of death from anti-microbial resistance. With the main aim to determine factors contributing to treatment outcomes observed among DR-TB patients in the countries in Eastern Europe and Central Asia (EECA), a multi-method study was conducted in: Azerbaijan, Belarus, Romania, Tajikistan and Ukraine. Both quantitative and qualitative methodologies were used for data collection and analysis. The quantitative approaches included a desk review of documents related to the DR-TB responses and an analysis of clinical records of DR-TB patients in selected health facilities of the five countries. Qualitative methods included in-depth interviews with national TB programme (NTP) managers, other healthcare providers and non-governmental organizations (NGOs) workers, as well as interviews and Focus Group Discussions (FGDs) with DR-TB patients. The desk review of 38 reports identified as the main challenges to address DR-TB financial and/or management issues and adverse events of the medicines. The most common recommendations related to treatment outcome focussed on general programme management, treatment regimen composition, clinical management and social support for the patients. In all the five countries the NTPs still have a vertical structure. Some integration into the primary health care system (PHC) already exists but further involvement of PHC facilities is feasible and recommended. Interviews with stakeholders indicated that alcoholism and homelessness and a lack of appropriate response to these issues remain as major challenges for a sub-set of patients. Civil society groups, NGOs and communities are substantially engaged in providing different services to DR-TB patients, especially in Ukraine, Romania and Tajikistan. Data from clinical records of 212 patients revealed that independent risk factors for unfavourable treatment outcome (death, loss to follow-up, failure) were culture-positivity at two months of treatment, history of treatment with second-line drugs and homelessness. More powerful, less toxic and shorter oral treatment regimens as well as comprehensive patient support are needed to improve treatment outcome of patients with DR-TB.
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Affiliation(s)
- Christian Auer
- Swiss Tropical and Public Health Institute, Basel; University of Basel.
| | | | | | | | - Alena Skrahina
- Republican Scientific and Practical Centre for Pulmonology and TB, Minsk.
| | | | - Florence Sécula
- Swiss Tropical and Public Health Institute, Basel; University of Basel.
| | | | | | - Giovanni Battista Migliori
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute IRCCS, Tradate.
| | - Nino Mdivani
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva.
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13
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Brown DW, Bosch-Capblanch X, Shimp L. Where Do We Go From Here? Defining an Agenda for Home-Based Records Research and Action Considering the 2018 WHO Guidelines. Glob Health Sci Pract 2019; 7:6-11. [PMID: 30877139 PMCID: PMC6538131 DOI: 10.9745/ghsp-d-18-00431] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/05/2019] [Indexed: 12/04/2022]
Abstract
Recent WHO guidelines point to knowledge gaps about home-based records despite their widespread use. Future research should explore their impact on health outcomes, challenges including production costs and confidentiality breaches, the role of design in their use, and the business case for investing in them.
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Affiliation(s)
- David W Brown
- Brown Consulting Group International LLC, Cornelius, NC, USA.
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14
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Auer C, Bosch-Capblanch X. Taking tuberculosis seriously requires that we take poverty seriously: reinstating the ethics of public health. Int J Tuberc Lung Dis 2018; 22:1390-1391. [DOI: 10.5588/ijtld.18.0604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Christian Auer
- Swiss Tropical and Public Health Institute, Basel, University of Basel, Basel, Switzerland
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, University of Basel, Basel, Switzerland
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15
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Muloliwa AM, Cliff J, Oku A, Oyo-Ita A, Glenton C, Ames H, Kaufman J, Hill S, Cartier Y, Bosch-Capblanch X, Rada G, Lewin S. Using the COMMVAC taxonomy to map vaccination communication interventions in Mozambique. Glob Health Action 2018; 10:1321313. [PMID: 28573937 PMCID: PMC5496065 DOI: 10.1080/16549716.2017.1321313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Improved communication about childhood vaccination is fundamental to increasing vaccine uptake in low-income countries. Mozambique, with 64% of children fully vaccinated, uses a range of communication interventions to promote uptake of childhood immunisation. OBJECTIVES Using a taxonomy developed by the 'Communicate to Vaccinate' (COMMVAC) project, the study aims to identify and classify the existing communication interventions for vaccination in Mozambique and to find the gaps. METHODS We used a qualitative research approach to identify the range of communication interventions used in Mozambique. In-depth semi-structured interviews were carried out with key purposively selected personnel at national level and relevant documents were collected and analysed. These data were complemented with observations of communication during routine vaccination and campaigns in Nampula province. We used the COMMVAC taxonomy, which organises vaccination communication intervention according to its intended purpose and the population targeted, to map both routine and campaign interventions. RESULTS We identified interventions used in campaign and routine vaccination, or in both, fitting five of the seven taxonomy purposes, with informing or educating community members predominating. We did not identify any interventions that aimed to provide support or facilitate decision-making. There were interventions for all main target groups, although fewer for health providers. Overlap occurred: for example, interventions often targeted both parents and community members. CONCLUSIONS We consider that the predominant focus on informing and educating community members is appropriate in the Mozambican context, where there is a high level of illiteracy and poor knowledge of the reasons for vaccination. We recommend increasing interventions for health providers, in particular training them in better communication for vaccination. The taxonomy was useful for identifying gaps, but needs to be more user-friendly if it is to be employed as a tool by health service managers.
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Affiliation(s)
| | - Julie Cliff
- b Faculdade de Medicina , Universidade Eduardo Mondlane , Maputo , Mozambique
| | - Afiong Oku
- c Community Medicine Department , University of Calabar , Calabar , Nigeria
| | - Angela Oyo-Ita
- c Community Medicine Department , University of Calabar , Calabar , Nigeria
| | - Claire Glenton
- d Global Health Unit , Norwegian Institute of Public Health , Oslo , Norway
| | - Heather Ames
- d Global Health Unit , Norwegian Institute of Public Health , Oslo , Norway
| | - Jessica Kaufman
- e Centre for Health Communication and Participation, School of Psychology and Public Health , La Trobe University , Melbourne , Australia
| | - Sophie Hill
- e Centre for Health Communication and Participation, School of Psychology and Public Health , La Trobe University , Melbourne , Australia
| | - Yuri Cartier
- f International Union for Health Promotion and Education , Saint-Maurice , France
| | - Xavier Bosch-Capblanch
- g Swiss Tropical and Public Health Institute , Basel , Switzerland.,h University of Basel , Basel , Switzerland
| | - Gabriel Rada
- i Evidence-based Healthcare Program , Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Simon Lewin
- d Global Health Unit , Norwegian Institute of Public Health , Oslo , Norway.,j Health Systems Research Unit , South African Medical Research Council , Tygerberg , South Africa
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16
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Auer C, Kiefer S, Zuske M, Schindler C, Wyss K, Blum J, Bosch-Capblanch X, Widmer U, Sauthier S, Janssens JP, Bossard K, Chatonnet C, Mazza-Stalder J, Začek B, Zellweger JP, Altpeter E, Mäusezahl M. Health-seeking behaviour and treatment delay in patients with pulmonary tuberculosis in Switzerland: some slip through the net. Swiss Med Wkly 2018; 148:w14659. [PMID: 30232794 DOI: 10.4414/smw.2018.14659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS OF THE STUDY To assess the health-seeking behaviour, the patient delay (onset of symptoms to first consultation) and the health system delay (first consultation to start of tuberculosis treatment) among patients with pulmonary tuberculosis (TB) diagnosed in Switzerland, and to assess the predictors of the various types of delay. METHODS A survey among pulmonary TB patients was carried out in six cantons, covering 42% of all pulmonary adult TB cases notified in Switzerland. Data were collected by collaborators of the cantonal lung associations in charge of the follow-up of TB patients to investigate treatment seeking behaviour and to establish various delays and its predictors. Predictors of percentiles of delay (median and 75th percentile) were assessed using quantile regression. RESULTS Among 252 eligible patients, 162 patients could be interviewed. Of these, 20.4% were born in Switzerland. Cough as a symptom was mentioned by 76% of the interviewed patients. Almost half of the 162 patients (46%) consulted first a general practitioner in an ambulatory care setting and 26% approached a hospital first. The median delay between symptom onset and first healthcare contact (patient delay) was 5.2 weeks, which is slightly longer than findings in other low prevalence countries. The interquartile range was 1.6 to 14.2 weeks. The median delay between first consultation in Switzerland and the start of TB treatment (health system delay) was 2 weeks. The interquartile range was 0.6 to 7.1 weeks. There were no clear predictors of patient delay. The main predictors of a longer median health system delay were the presence of fever (1.6 weeks, 95% confidence interval [CI] 0.5 to 2.6 weeks), having visited first a general practitioner or a paediatrician (1 week, 95% CI 0.1 to 1.9 weeks) and having seen three or four doctors before beginning TB treatment (2.9 weeks, 95% CI 0.7 to 5.1 weeks). A clear predictor of a shorter median health system delay was having undergone an X-ray at the first consultation (-2.9 weeks, 95% CI -4.8 to -0.9 weeks). Marginally significant for shorter delay was male sex (-2.6 weeks, 95% CI -5.4 to 0.1 weeks). CONCLUSIONS No predictor of patient delay was found among the variables collected. For one fourth of the patients, the health system delay was longer than 7 weeks. General practitioners are commonly approached first, and they have to consider TB, also for patients not considered at high-risk for TB.
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Affiliation(s)
- Christian Auer
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Sabine Kiefer
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Meike Zuske
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Johannes Blum
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Ursula Widmer
- Lung Association of Canton Aargau, Aarau, Switzerland
| | - Sonia Sauthier
- Division of Pneumology, Department of Medical Specialities, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Paul Janssens
- Division of Pneumology, Department of Medical Specialities, Geneva University Hospitals, Geneva, Switzerland
| | | | - Christophe Chatonnet
- Lung Association of Canton Vaud (Ligue Pulmonaire Vaudoise), Lausanne, Switzerland
| | - Jesica Mazza-Stalder
- Division of Respiratory Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bea Začek
- TB Centre of the Lung Association of Canton Zurich (Verein Lunge Zürich), Zurich, Switzerland
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17
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Brouwers MC, Ako-Arrey D, Spithoff K, Vukmirovic M, Florez ID, Lavis JN, Cluzeau F, Permanand G, Bosch-Capblanch X, Chen Y. Validity and usability testing of a health systems guidance appraisal tool, the AGREE-HS. Health Res Policy Syst 2018; 16:51. [PMID: 29925394 PMCID: PMC6011397 DOI: 10.1186/s12961-018-0334-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 06/05/2018] [Indexed: 12/01/2022] Open
Abstract
Background Health systems guidance (HSG) provides recommendations to address health systems challenges. No tools exist to inform HSG developers and users about the components of high quality HSG and to differentiate between HSG of varying quality. In response, we developed a tool to assist with the development, reporting and appraisal of HSG – the Appraisal of Guidelines for Research and Evaluation–Health Systems (AGREE-HS). This paper reports on the validity, usability and initial measurement properties of the AGREE-HS. Methods To establish face validity (Study 1), stakeholders completed a survey about the AGREE-HS and provided feedback on its content and structure. Revisions to the tool were made in response. To establish usability (Study 2), the revised tool was applied to 85 HSG documents and the appraisers provided feedback about their experiences via an online survey. An initial test of the revised tool’s measurement properties, including internal consistency, inter-rater reliability and criterion validity, was conducted. Additional revisions to the tool were made in response. Results In Study 1, the AGREE-HS Overview, User Manual, quality item content and structure, and overall assessment questions were rated favourably. Participants indicated that the AGREE-HS would be useful, feasible to use, and that they would apply it in their context. In Study 2, participants indicated that the quality items were easy to understand and apply, and the User Manual, usefulness and usability of the tool were rated favourably. Study 2 participants also indicated intentions to use the AGREE-HS. Conclusions The AGREE-HS comprises a User Manual, five quality items and two overall assessment questions. It is available at agreetrust.org. Electronic supplementary material The online version of this article (10.1186/s12961-018-0334-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melissa C Brouwers
- McMaster University, Juravinski Site, G2 Wing, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Denis Ako-Arrey
- McMaster University, Juravinski Site, G2 Wing, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Karen Spithoff
- McMaster University, Juravinski Site, G2 Wing, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Marija Vukmirovic
- McMaster University, Juravinski Site, G2 Wing, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Ivan D Florez
- McMaster University, Juravinski Site, G2 Wing, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - John N Lavis
- McMaster University, 1280 Main Street West MML-417, Hamilton, ON, L8S 4L8, Canada
| | - Francoise Cluzeau
- Imperial College London, St. Mary's Hospital (Room 1070, Queen Elizabeth the Mother Wing), Praed Street, London, W2 1NY, United Kingdom
| | - Govin Permanand
- The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.,Universität Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Yaolong Chen
- Lanzhou University (Evidence Based Medicine Center), 222 Tianshui S Rd, Chengguan Qu, Lanzhou Shi, Gansu Sheng, China
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18
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Ames H, Njang DM, Glenton C, Fretheim A, Kaufman J, Hill S, Oku A, Cliff J, Cartier Y, Bosch-Capblanch X, Rada G, Muloliwa AM, Oyo-Ita A, Kum AP, Lewin S. Stakeholder perceptions of communication about vaccination in two regions of Cameroon: A qualitative case study. PLoS One 2017; 12:e0183721. [PMID: 28859101 PMCID: PMC5578665 DOI: 10.1371/journal.pone.0183721] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding stakeholders' (parents', communities' and health workers') perspectives of communication about childhood vaccination, including their preferences for its format, delivery and content, is an important step towards designing better communication strategies and ensuring more informed parents. Our objectives were to explore stakeholders' views, experiences and preferences for childhood vaccination communication in Cameroon. METHODS In 2014, in the Central and North West Regions of Cameron, we gathered qualitative data for our case study using the following methods: semi structured interviews; observations and informal conversations during routine immunization clinics and three rounds of the National Polio Immunization Campaign; document analysis of reports and mass media communications about vaccination; and a survey of parents. We conducted a thematic analysis of the qualitative data to identify themes relating to views, experiences and perceptions of vaccination information and its delivery. Survey data were analysed using simple descriptive statistics. RESULTS All of the parents interviewed felt that vaccinating their child was important, and trusted the information provided by health workers. However, many parents wanted more information. Parents did not always feel that they could ask questions during vaccination appointments. All participants felt that health workers and vaccination clinics were important sources of information. Social mobilisation activities such as door-to-door visits and announcements during religious services were important and accepted ways of communicating information, especially during vaccination campaigns. Information communicated through mass media and text messages was also seen as important. In general, stakeholders believed that more consistent messaging about routine vaccination through community channels would be helpful to remind parents of the importance of routine vaccination during ongoing rounds of vaccination campaigns against polio. CONCLUSIONS This study confirms that parents regard information about childhood vaccination as important, but that health services need to be organized in ways that prioritize and facilitate communication, particularly about routine vaccination.
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Affiliation(s)
- Heather Ames
- Global Health Unit, Norwegian Institute of Public Health, Oslo, Norway
| | - Diangha Mabel Njang
- Department of Anthropology, University of Yaoundé 1, Yaoundé, Central Province, Cameroon
| | - Claire Glenton
- Global Health Unit, Norwegian Institute of Public Health, Oslo, Norway
| | - Atle Fretheim
- Global Health Unit, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Health and Society, University of Oslo, 0318 Oslo Norway
| | - Jessica Kaufman
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Afiong Oku
- University of Calabar, Nigeria, Calabar Municipal, Cross River State, Nigeria
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Yuri Cartier
- International Union for Health Promotion and Education, Cedex, France
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Gabriel Rada
- Evidence-based Healthcare Programme, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Angela Oyo-Ita
- University of Calabar, Nigeria, Calabar Municipal, Cross River State, Nigeria
| | - Awah Paschal Kum
- Department of Anthropology, University of Yaoundé 1, Yaoundé, Central Province, Cameroon
| | - Simon Lewin
- Global Health Unit, Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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19
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Kaufman J, Ryan R, Lewin S, Bosch-Capblanch X, Glenton C, Cliff J, Oyo-Ita A, Muloliwa AM, Oku A, Ames H, Rada G, Cartier Y, Hill S. Identification of preliminary core outcome domains for communication about childhood vaccination: An online Delphi survey. Vaccine 2017; 36:6520-6528. [PMID: 28835344 DOI: 10.1016/j.vaccine.2017.08.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/04/2017] [Accepted: 08/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication interventions for childhood vaccination are promising strategies to address vaccine hesitancy, but current research is limited by the outcomes measured. Most studies measure only vaccination-related outcomes, with minimal consideration of vaccine hesitancy-relevant intermediate outcomes. This impedes understanding of which interventions or elements are effective. It is also unknown which outcomes are important to the range of stakeholders affected by vaccine hesitancy. Outcome selection shapes the evidence base, informing future interventions and trials, and should reflect stakeholder priorities. Therefore, our aim was to identify which outcome domains (i.e. broad outcome categories) are most important to different stakeholders, identifying preliminary core outcome domains to inform evaluation of three common vaccination communication types: (i) communication to inform or educate, (ii) remind or recall, and (iii) enhance community ownership. METHODS We conducted a two-stage online Delphi survey, involving four stakeholder groups: parents or community members, healthcare providers, researchers, and government or non-governmental organisation representatives. Participants rated the importance of eight outcome domains for each of the three communication types. They also rated specific outcomes within one domain ("attitudes or beliefs") and provided feedback about the survey. RESULTS Collectively, stakeholder groups prioritised outcome domains differently when considering the effects of different communication types. For communication that aims to (i) inform or educate, the most important outcome domain is "knowledge or understanding"; for (ii) reminder communication, "vaccination status and behaviours"; and for (iii) community engagement communication, "community participation". All stakeholder groups rated most outcome domains as very important or critical. The highest rated specific outcome within the "attitudes or beliefs" domain was "trust". CONCLUSION This Delphi survey expands the field of core outcomes research and identifies preliminary core outcome domains for measuring the effects of communication about childhood vaccination. The findings support the argument that vaccination communication is not a single homogenous intervention - it has a range of purposes, and vaccination communication evaluators should select outcomes accordingly.
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Affiliation(s)
- Jessica Kaufman
- Centre for Health Communication and Participation, Health Sciences 2, School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia.
| | - Rebecca Ryan
- Centre for Health Communication and Participation, Health Sciences 2, School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia.
| | - Simon Lewin
- Norwegian Institute of Public Health, Boks 7004, St Olavs plass, 0130 Oslo, Norway; Health Systems Research Unit, South African Medical Research Council, P.O. Box 19070, 7505 Tygerberg, Cape Town, South Africa.
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Claire Glenton
- Norwegian Institute of Public Health, Boks 7004, St Olavs plass, 0130 Oslo, Norway.
| | - Julie Cliff
- Faculdade de Medicina, Eduardo Mondlane University, CP 257 Maputo, Mozambique.
| | - Angela Oyo-Ita
- University of Calabar, PMB 1115 Calabar, Cross River State, Nigeria.
| | - Artur Manuel Muloliwa
- Provincial Directorate of Health, Av. Samora Machel n° 1016 R/C, C.P. N° 14, Nampula, Mozambique.
| | - Afiong Oku
- University of Calabar, PMB 1115 Calabar, Cross River State, Nigeria.
| | - Heather Ames
- Norwegian Institute of Public Health, Boks 7004, St Olavs plass, 0130 Oslo, Norway.
| | - Gabriel Rada
- Pontifical Catholic University of Chile, Avda. Libertador Bernardo O'Higgins 340, Santiago, Chile.
| | - Yuri Cartier
- International Union for Health Promotion and Education, 42 Boulevard de la Libération, 93203 Saint-Denis, France.
| | - Sophie Hill
- Centre for Health Communication and Participation, Health Sciences 2, School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia.
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Bosch-Capblanch X, Zuske MK, Auer C. Research on subgroups is not research on equity attributes: Evidence from an overview of systematic reviews on vaccination. Int J Equity Health 2017; 16:95. [PMID: 28592273 PMCID: PMC5463415 DOI: 10.1186/s12939-017-0587-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 05/22/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Equity remains a priority in the international health development agenda. However, major inequities in vaccination coverage jeopardise the achievement of the Sustainable Development Goals. We aim at comprehensively describing how research has addressed equity issues related to vaccination. METHODS We carried out an overview of systematic reviews (SRs) that explicitly explored the effects of interventions to improve vaccination in any context; for any vaccine and, in any language. We followed standard research synthesis methods to systematically search for SR, assess them for inclusion and extracting relevant data, particularly on vaccination related outcomes. To gather evidence on equity issues addressed in the SR, we used the PROGRESS-plus framework. FINDINGS Our search obtained 2,003 hits which resulted in 54 included SRs, published between 1994 and 2014. The quality of SRs was generally poor, with less than half complying with most of the quality criteria. Reported vaccines included, by order of frequency, influenza and Expanded Programme on Immunisation vaccines. The types of interventions more frequently reported were related to vaccination delivery strategies, financial support and information, education and communication. Most of the SRs suggested effects favouring intervention groups as opposed to comparison groups. The most frequently reported equity attribute was 'place of residence' and the least reported equity attributes were sexual orientation and religion. Very few estimates of effects actually measured differences or changes between groups having those attributes and all of them referred to the place of residence. No data was found about reducing equity gaps for vulnerable groups or minorities, or attributes such as sexual orientation, education or specific religious groups. CONCLUSIONS Although research on vulnerable populations as a subgroup is abundant, it fails to report on the interventions that will actually reduce inequities and consider how redistribution of health care resources could shrink the gap between the privileged and most vulnerable groups including minorities. Research, if aiming at being responsive to global health policy trends, needs to report not only on specific attributes but also on how a better redistribution of health care resources could contribute to alleviating the unjust situation of the most vulnerable populations.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
- Universität Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Meike-Kathrin Zuske
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
- Universität Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
- Universität Basel, Petersplatz 1, 4003 Basel, Switzerland
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21
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Kaufman J, Ames H, Bosch-Capblanch X, Cartier Y, Cliff J, Glenton C, Lewin S, Muloliwa AM, Oku A, Oyo-Ita A, Rada G, Hill S. The comprehensive 'Communicate to Vaccinate' taxonomy of communication interventions for childhood vaccination in routine and campaign contexts. BMC Public Health 2017; 17:423. [PMID: 28486956 PMCID: PMC5424416 DOI: 10.1186/s12889-017-4320-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background Communication can be used to generate demand for vaccination or address vaccine hesitancy, and is crucial to successful childhood vaccination programmes. Research efforts have primarily focused on communication for routine vaccination. However, vaccination campaigns, particularly in low- or middle-income countries (LMICs), also use communication in diverse ways. Without a comprehensive framework integrating communication interventions from routine and campaign contexts, it is not possible to conceptualise the full range of possible vaccination communication interventions. Therefore, vaccine programme managers may be unaware of potential communication options and researchers may not focus on building evidence for interventions used in practice. In this paper, we broaden the scope of our existing taxonomy of communication interventions for routine vaccination to include communication used in campaigns, and integrate these into a comprehensive taxonomy of vaccination communication interventions. Methods Building on our taxonomy of communication for routine vaccination, we identified communication interventions used in vaccination campaigns through a targeted literature search; observation of vaccination activities in Cameroon, Mozambique and Nigeria; and stakeholder consultations. We added these interventions to descriptions of routine vaccination communication and categorised the interventions according to their intended purposes, building from an earlier taxonomy of communication related to routine vaccination. Results The comprehensive taxonomy groups communication used in campaigns and routine childhood vaccination into seven purpose categories: ‘Inform or Educate’; ‘Remind or Recall’; ‘Enhance Community Ownership’; ‘Teach Skills’; ‘Provide Support’; ‘Facilitate Decision Making’ and ‘Enable Communication’. Consultations with LMIC stakeholders and experts informed the taxonomy’s definitions and structure and established its potential uses. Conclusions This taxonomy provides a standardised way to think and speak about vaccination communication. It is categorised by purpose to help conceptualise communication interventions as potential solutions to address needs or problems. It can be utilised by programme planners, implementers, researchers and funders to see the range of communication interventions used in practice, facilitate evidence synthesis and identify evidence gaps. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4320-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jessica Kaufman
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Heather Ames
- Norwegian Institute of Public Health, Oslo, Norway
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Yuri Cartier
- International Union for Health Promotion and Education, Saint-Maurice Cedex, France
| | - Julie Cliff
- Eduardo Mondlane University, Maputo, Mozambique
| | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway.,South African Medical Research Council, Cape Town, South Africa
| | | | | | | | - Gabriel Rada
- Pontifical Catholic University of Chile, Santiago, Chile
| | - Sophie Hill
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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22
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Kaufman J, Ryan R, Glenton C, Lewin S, Bosch-Capblanch X, Cartier Y, Cliff J, Oyo-Ita A, Ames H, Muloliwa AM, Oku A, Rada G, Hill S. Childhood vaccination communication outcomes unpacked and organized in a taxonomy to facilitate core outcome establishment. J Clin Epidemiol 2017; 84:173-184. [PMID: 28238788 DOI: 10.1016/j.jclinepi.2017.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/11/2017] [Accepted: 02/18/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We present a comprehensive taxonomy of outcomes for childhood vaccination communication interventions. Adding to our earlier map of trial outcomes, we aimed to (1) identify relevant outcomes not measured in trials, (2) identify outcomes from stakeholder focus groups, and (3) organize outcomes into a taxonomy. STUDY DESIGN AND SETTING We identified additional outcomes from nonvaccination health communication literature and through parent and health care professional focus groups. We organized outcomes into the taxonomy through iterative discussion and informed by organizational principles established by leaders in core outcome research. RESULTS The taxonomy includes three overarching core areas, divided into eight domains and then into outcomes. Core area one is psychosocial impact, including the domains "knowledge or understanding," "attitudes or beliefs," and "decision-making." Core area two is health impact, covering "vaccination status and behaviors" and "health status and well-being." Core area three is community, social, or health system impact, containing "intervention design and implementation," "community participation," and "resource use." CONCLUSION To our knowledge, this taxonomy is the first attempt to conceptualize the range of potential outcomes for vaccination communication. It can be used by researchers selecting outcomes for complex communication interventions. We will also present the taxonomy to stakeholders to establish core outcome domains.
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Affiliation(s)
- Jessica Kaufman
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Rm 412, Bundoora, Victoria 3086, Australia.
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Rm 412, Bundoora, Victoria 3086, Australia
| | - Claire Glenton
- Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo N-0403, Norway
| | - Simon Lewin
- Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo N-0403, Norway; Health Systems Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg 7505, Cape Town, South Africa
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland; Universität Basel, Petersplatz 1, CH-4003, Basel, Switzerland
| | - Yuri Cartier
- International Union for Health Promotion and Education, 42 boulevard de la Libération, Saint-Denis 93203, France
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo CP 257, Mozambique
| | - Angela Oyo-Ita
- Department of Community Medicine, University of Calabar, Calabar PMB 1115, Cross River State, Nigeria
| | - Heather Ames
- Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo N-0403, Norway
| | - Artur Manuel Muloliwa
- Provincial Directorate of Health, Av. Samora Machel n(º) 1016 R/C, C.P. N(º) 14, Nampula, Mozambique
| | - Afiong Oku
- Department of Community Medicine, University of Calabar, Calabar PMB 1115, Cross River State, Nigeria
| | - Gabriel Rada
- Evidence Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Avda, Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Rm 412, Bundoora, Victoria 3086, Australia
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Oku A, Oyo-Ita A, Glenton C, Fretheim A, Eteng G, Ames H, Muloliwa A, Kaufman J, Hill S, Cliff J, Cartier Y, Bosch-Capblanch X, Rada G, Lewin S. Factors affecting the implementation of childhood vaccination communication strategies in Nigeria: a qualitative study. BMC Public Health 2017; 17:200. [PMID: 28202001 PMCID: PMC5311723 DOI: 10.1186/s12889-017-4020-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 01/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of health communication in vaccination programmes cannot be overemphasized: it has contributed significantly to creating and sustaining demand for vaccination services and improving vaccination coverage. In Nigeria, numerous communication approaches have been deployed but these interventions are not without challenges. We therefore aimed to explore factors affecting the delivery of vaccination communication in Nigeria. METHODS We used a qualitative approach and conducted the study in two states: Bauchi and Cross River States in northern and southern Nigeria respectively. We identified factors affecting the implementation of communication interventions through interviews with relevant stakeholders involved in vaccination communication in the health services. We also reviewed relevant documents. Data generated were transcribed verbatim and analysed using thematic analysis. RESULTS We used the SURE framework to organise the identified factors (barriers and facilitators) affecting vaccination communication delivery. We then grouped these into health systems and community level factors. Some of the commonly reported health system barriers amongst stakeholders interviewed included: funding constraints, human resource factors (health worker shortages, training deficiencies, poor attitude of health workers and vaccination teams), inadequate infrastructure and equipment and weak political will. Community level factors included the attitudes of community stakeholders and of parents and caregivers. We also identified factors that appeared to facilitate communication activities. These included political support, engagement of traditional and religious institutions and the use of organised communication committees. CONCLUSIONS Communication activities are a crucial element of immunization programmes. It is therefore important for policy makers and programme managers to understand the barriers and facilitators affecting the delivery of vaccination communication so as to be able to implement communication interventions more effectively.
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Affiliation(s)
- Afiong Oku
- Community Medicine Department, University of Calabar, P.M.B 1115, Calabar Municipality, Cross River State, Nigeria
| | - Angela Oyo-Ita
- Community Medicine Department, University of Calabar, P.M.B 1115, Calabar Municipality, Cross River State, Nigeria
| | - Claire Glenton
- Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway
| | - Atle Fretheim
- Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway.,Institute of Health and Society, University of Oslo, P.O box 1130, Blindern, 0318, Oslo, Norway
| | - Glory Eteng
- Sociology Department, University of Calabar, P.M.B 1115, Calabar Municipality, Cross River State, Nigeria
| | - Heather Ames
- Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway
| | - Artur Muloliwa
- Departamento de Saúde, Direcção Provincial de Saúde de Nampula, Av. SamoraMachel n° 1016 R/C, C.P. N° 14, Nampula, Mozambique
| | - Jessica Kaufman
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2, Victoria, 3086, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2, Victoria, 3086, Australia
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Yuri Cartier
- International Union for Health Promotion and Education, 42 Blvd. de la Libération, 95203, St. Denis, Cedex, France
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Gabriel Rada
- Evidence-based Healthcare Program, Pontificia Universidad Católica de Chile, Avda. Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - Simon Lewin
- Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway. .,Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, PO Box 19070, 7505, Tygerberg, South Africa.
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Oku A, Oyo-Ita A, Glenton C, Fretheim A, Ames H, Muloliwa A, Kaufman J, Hill S, Cliff J, Cartier Y, Bosch-Capblanch X, Rada G, Lewin S. Communication strategies to promote the uptake of childhood vaccination in Nigeria: a systematic map. Glob Health Action 2016; 9:30337. [PMID: 26880154 PMCID: PMC4754015 DOI: 10.3402/gha.v9.30337] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Effective communication is a critical component in ensuring that children are fully vaccinated. Although numerous communication interventions have been proposed and implemented in various parts of Nigeria, the range of communication strategies used has not yet been mapped systematically. This study forms part of the 'Communicate to vaccinate' (COMMVAC) project, an initiative aimed at building research evidence for improving communication with parents and communities about childhood vaccinations in low- and middle-income countries. OBJECTIVE This study aims to: 1) identify the communication strategies used in two states in Nigeria; 2) map these strategies against the existing COMMVAC taxonomy, a global taxonomy of vaccination communication interventions; 3) create a specific Nigerian country map of interventions organised by purpose and target; and 4) analyse gaps between the COMMVAC taxonomy and the Nigerian map. DESIGN We conducted the study in two Nigerian states: Bauchi State in Northern Nigeria and Cross River State in Southern Nigeria. We identified vaccination communication interventions through interviews carried out among purposively selected stakeholders in the health services and relevant agencies involved in vaccination information delivery; through observations and through relevant documents. We used the COMMVAC taxonomy to organise the interventions we identified based on the intended purpose of the communication and the group to which the intervention was targeted. RESULTS The Nigerian map revealed that most of the communication strategies identified aimed to inform and educate and remind or recall. Few aimed to teach skills, enhance community ownership, and enable communication. We did not identify any intervention that aimed to provide support or facilitate decision-making. Many interventions had more than one purpose. The main targets for most interventions were caregivers and community members, with few interventions directed at health workers. Most interventions identified were used in the context of campaigns rather than routine immunisation programmes. CONCLUSIONS The identification and development of the Nigerian vaccination communication interventions map could assist programme managers to identify gaps in vaccination communication. The map may be a useful tool as part of efforts to address vaccine hesitancy and improve vaccination coverage in Nigeria and similar settings.
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Affiliation(s)
- Afiong Oku
- Community Medicine Department, University of Calabar, Calabar, Nigeria;
| | - Angela Oyo-Ita
- Community Medicine Department, University of Calabar, Calabar, Nigeria
| | - Claire Glenton
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Atle Fretheim
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Heather Ames
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Artur Muloliwa
- Departamento de Saúde, Direcção Provincial de Saúde de Nampula, Nampula, Mozambique
| | - Jessica Kaufman
- Department of Human Biosciences, Centre for Health Communication and Participation, College of Science, Health and Engineering La Trobe University, Melbourne, Australia
| | - Sophie Hill
- Department of Human Biosciences, Centre for Health Communication and Participation, College of Science, Health and Engineering La Trobe University, Melbourne, Australia
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Yuri Cartier
- International Union for Health Promotion and Education, Cedex, France
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Gabriel Rada
- Evidence-based Healthcare Program, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Simon Lewin
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
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Ames H, Njang DM, Glenton C, Fretheim A, Kaufman J, Hill S, Oku A, Cliff J, Cartier Y, Bosch-Capblanch X, Rada G, Muloliwa A, Oyo-Ita A, Lewin S. Mapping how information about childhood vaccination is communicated in two regions of Cameroon: What is done and where are the gaps? BMC Public Health 2015; 15:1264. [PMID: 26691846 PMCID: PMC4687068 DOI: 10.1186/s12889-015-2557-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022] Open
Abstract
Background The ‘Communicate to vaccinate’ (COMMVAC) project builds research evidence for improving communication with parents and communities about childhood vaccinations in low- and middle-income countries. Understanding and mapping the range of vaccination communication strategies used in different settings is an important component of this work. In this part of the COMMVAC project, our objectives were: (1) to identify the vaccination communication interventions used in two regions of Cameroon; (2) to apply the COMMVAC taxonomy, a global taxonomy of vaccination communication interventions, to these communication interventions to help us classify these interventions, including their purposes and target audiences; and identify whether gaps in purpose or target audiences exist; (3) to assess the COMMVAC taxonomy as a research tool for data collection and analysis. Methods We used the following qualitative methods to identify communication strategies in the Central and North West Regions of Cameroon in the first half of 2014: interviews with program managers, non-governmental organizations, vaccinators, parents and community members; observations and informal conversations during routine immunization clinics and three rounds of the National Polio Immunization Campaign; and document analysis of reports and mass media communications about vaccination. A survey of parents and caregivers was also done. We organised the strategies using the COMMVAC taxonomy and produced a map of Cameroon-specific interventions, which we presented to local stakeholders for feedback. Results Our map of the interventions used in Cameroon suggests that most childhood vaccination communication interventions focus on national campaigns against polio rather than routine immunisation. The map also indicates that most communication interventions target communities more broadly, rather than parents, and that very few interventions target health workers. The majority of the communication interventions aimed to inform or educate or remind or recall members of the community about vaccination. The COMMVAC taxonomy provided a useful framework for quickly and simply mapping existing vaccination communication strategies. Conclusions By identifying the interventions used in Cameroon and developing an intervention map, we allowed stakeholders to see where they were concentrating their communication efforts and where gaps exist, allowing them to reflect on whether changes are needed to the communication strategies they are using. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2557-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heather Ames
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Boks 7004, St Olavs plass, N/0130, Oslo, Norway.
| | - Diangha Mabel Njang
- Department of Anthropology, University of Yaoundé 1, BP 337, Yaoundé, Central Province, Cameroon, Africa.
| | - Claire Glenton
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Boks 7004, St Olavs plass, N/0130, Oslo, Norway.
| | - Atle Fretheim
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Boks 7004, St Olavs plass, N/0130, Oslo, Norway. .,Institute of Health and Society, University of Oslo, P.O box 1130 Blindern 0318, Oslo, Norway.
| | - Jessica Kaufman
- Centre for Health Communication and Participation, C/o Department of Human Biosciences, College of Science, Health and Engineering, La Trobe University, Melbourne campus, 3086, VIC, Australia.
| | - Sophie Hill
- Centre for Health Communication and Participation, C/o Department of Human Biosciences, College of Science, Health and Engineering, La Trobe University, Melbourne campus, 3086, VIC, Australia.
| | - Afiong Oku
- University of Calabar, Nigeria, P.M.B 1115, Calabar Municipal, Cross River State, Nigeria.
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique, Africa.
| | - Yuri Cartier
- International Union for Health Promotion and Education, 42 Blvd. de la Libération, 95203 St, Denis, Cedex, France.
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland. .,University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Gabriel Rada
- Evidence-based Healthcare Program, Pontificia Universidad Católica de Chile, Avda. Libertador Bernardo O'Higgins 340, Santiago, Chile.
| | - Artur Muloliwa
- Direcção Provincial de Saúde de Nampula, Departamento de Saúde, Av. Samora Machel n° 1016 R/C, C.P. N° 14, Nampula-Moçambique, Africa.
| | - Angela Oyo-Ita
- University of Calabar, Nigeria, P.M.B 1115, Calabar Municipal, Cross River State, Nigeria.
| | - Simon Lewin
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Boks 7004, St Olavs plass, N/0130, Oslo, Norway. .,Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, PO Box 19070, 7505, Tygerberg, South Africa.
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Merten S, Martin Hilber A, Biaggi C, Secula F, Bosch-Capblanch X, Namgyal P, Hombach J. Gender Determinants of Vaccination Status in Children: Evidence from a Meta-Ethnographic Systematic Review. PLoS One 2015; 10:e0135222. [PMID: 26317975 PMCID: PMC4552892 DOI: 10.1371/journal.pone.0135222] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/20/2015] [Indexed: 11/26/2022] Open
Abstract
Using meta-ethnographic methods, we conducted a systematic review of qualitative research to understand gender-related reasons at individual, family, community and health facility levels why millions of children in low and middle income countries are still not reached by routine vaccination programmes. A systematic search of Medline, Embase, CINAHL, Cochrane Library, ERIC, Anthropological Lit, CSA databases, IBSS, ISI Web of Knowledge, JSTOR, Soc Index and Sociological Abstracts was conducted. Key words were built around the themes of immunization, vaccines, health services, health behaviour, and developing countries. Only papers, which reported on in-depth qualitative data, were retained. Twenty-five qualitative studies, which investigated barriers to routine immunisation, were included in the review. These studies were conducted between 1982 and 2012; eighteen were published after 2000. The studies represent a wide range of low- to middle income countries including some that have well known coverage challenges. We found that women's low social status manifests on every level as a barrier to accessing vaccinations: access to education, income, as well as autonomous decision-making about time and resource allocation were evident barriers. Indirectly, women's lower status made them vulnerable to blame and shame in case of childhood illness, partly reinforcing access problems, but partly increasing women's motivation to use every means to keep their children healthy. Yet in settings where gender discrimination exists most strongly, increasing availability and information may not be enough to reach the under immunised. Programmes must actively be designed to include mitigation measures to facilitate women's access to immunisation services if we hope to improve immunisation coverage. Gender inequality needs to be addressed on structural, community and household levels if the number of unvaccinated children is to substantially decrease.
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Affiliation(s)
- Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Adriane Martin Hilber
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Christina Biaggi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Florence Secula
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Pem Namgyal
- Initiative for Vaccines Research, World Health Organization, Geneva, Switzerland
| | - Joachim Hombach
- Initiative for Vaccines Research, World Health Organization, Geneva, Switzerland
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Langlois EV, Ranson MK, Bärnighausen T, Bosch-Capblanch X, Daniels K, El-Jardali F, Ghaffar A, Grimshaw J, Haines A, Lavis JN, Lewin S, Meng Q, Oliver S, Pantoja T, Straus S, Shemilt I, Tovey D, Tugwell P, Waddington H, Wilson M, Yuan B, Røttingen JA. Advancing the field of health systems research synthesis. Syst Rev 2015; 4:90. [PMID: 26159806 PMCID: PMC4498528 DOI: 10.1186/s13643-015-0080-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 06/17/2015] [Indexed: 11/10/2022] Open
Abstract
Those planning, managing and working in health systems worldwide routinely need to make decisions regarding strategies to improve health care and promote equity. Systematic reviews of different kinds can be of great help to these decision-makers, providing actionable evidence at every step in the decision-making process. Although there is growing recognition of the importance of systematic reviews to inform both policy decisions and produce guidance for health systems, a number of important methodological and evidence uptake challenges remain and better coordination of existing initiatives is needed. The Alliance for Health Policy and Systems Research, housed within the World Health Organization, convened an Advisory Group on Health Systems Research (HSR) Synthesis to bring together different stakeholders interested in HSR synthesis and its use in decision-making processes. We describe the rationale of the Advisory Group and the six areas of its work and reflects on its role in advancing the field of HSR synthesis. We argue in favour of greater cross-institutional collaborations, as well as capacity strengthening in low- and middle-income countries, to advance the science and practice of health systems research synthesis. We advocate for the integration of quasi-experimental study designs in reviews of effectiveness of health systems intervention and reforms. The Advisory Group also recommends adopting priority-setting approaches for HSR synthesis and increasing the use of findings from systematic reviews in health policy and decision-making.
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Affiliation(s)
- Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, 20 avenue Appia, 1211, Geneva, Switzerland.
| | - Michael K Ranson
- World Bank Group, 3 Chemin Louis-Dunant, Post Office Box 66 CH, 1211, Geneva, Switzerland.
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
- Wellcome Trust Africa Centre for Health and Population Studies, University of KwaZulu-Natal, R618 en route to Hlabisa, Somkhele A2074 Rd, Mtubatuba, 3935, South Africa.
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Karen Daniels
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive Parowvallei, Cape , PO Box 19070 , 7505, , Tygerberg, South Africa.
| | - Fadi El-Jardali
- Department of Health Management and Policy, Center for Systematic Reviews of Health Policy and Systems Research (SPARK), Faculty of Health Sciences, Van Dyck Hall, American University of Beirut, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, 20 avenue Appia, 1211, Geneva, Switzerland.
| | - Jeremy Grimshaw
- Ottawa Hospital Research Institute & Department of Medicine, University of Ottawa, 725 Parkdale Ave, Ottawa, ON, K1Y 4E9, Canada.
| | - Andy Haines
- Departments of Social and Environmental Health Research and of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - John N Lavis
- Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
- Department of Clinical Epidemiology & Biostatistics, Department of Political Science, and McMaster Health Forum, PPD/CHEPA, McMaster University, 1280 Main Street West, CRL-209, Hamilton, ON, L8S 4K1, Canada.
| | - Simon Lewin
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive Parowvallei, Cape , PO Box 19070 , 7505, , Tygerberg, South Africa.
- Cochrane Effective Practice and Organisation of Care Group (EPOC) Satellite, Norwegian Knowledge Centre for the Health Services, Box 7004, St. Olavs plass, 0130, Oslo, Norway.
| | - Qingyue Meng
- China Centre for Health Development Studies, Peking University, PO 505, XueYuan Road 38, Haidian District, Beijing, 100191, China.
| | - Sandy Oliver
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Institute of Education, University College London, 20 Bedford Way, London, WC1H 0AL, UK.
| | - Tomás Pantoja
- Departamento de Medicina Familiar, Escuela de Medicina, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O Higgins 340, Santiago, Chile.
| | - Sharon Straus
- St. Michael's hospital, Li Ka Shing Knowledge Institute, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Ian Shemilt
- Behaviour and Health Research Unit, School of Clinical Medicine, University of Cambridge, Box 113 Cambridge Biomedical Campus Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
| | - David Tovey
- Cochrane, St Albans House, 57-59 Haymarket, London, SW1Y 4QX, UK.
| | - Peter Tugwell
- Department of Medicine, Centre for Global Health, WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Institute of Population Health, Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Office 302, Ottawa, ON, K1R 6M1, Canada.
| | - Hugh Waddington
- International Initiative for Impact Evaluation, 36 Gordon Square, London, WC1H 0PD, UK.
| | - Mark Wilson
- Cochrane, St Albans House, 57-59 Haymarket, London, SW1Y 4QX, UK.
| | - Beibei Yuan
- China Centre for Health Development Studies, Peking University, PO 505, XueYuan Road 38, Haidian District, Beijing, 100191, China.
| | - John-Arne Røttingen
- Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
- Department of Health Management and Health Economics, Faculty of Medicine, Institute of Health and Society, University of Oslo, Postboks 1089, Blindern, 0317, Oslo, Norway.
- Division of Infectious Disease Control, Norwegian Institute of Public Health, PO Box 4404, , N-0403, Oslo, Norway.
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Bonenberger M, Aikins M, Akweongo P, Bosch-Capblanch X, Wyss K. What Do District Health Managers in Ghana Use Their Working Time for? A Case Study of Three Districts. PLoS One 2015; 10:e0130633. [PMID: 26068907 PMCID: PMC4465977 DOI: 10.1371/journal.pone.0130633] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/21/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ineffective district health management potentially impacts on health system performance and service delivery. However, little is known about district health managing practices and time allocation in resource-constrained health systems. Therefore, a time use study was conducted in order to understand current time use practices of district health managers in Ghana. METHODS All 21 district health managers working in three districts of the Eastern Region were included in the study and followed for a period of three months. Daily retrospective interviews about their time use were conducted, covering 1182 person-days of observation. Total time use of the sample population was assessed as well as time use stratified by managerial position. Differences of time use over time were also evaluated. RESULTS District health managers used most of their working time for data management (16.6%), attending workshops (12.3%), financial management (8.7%), training of staff (7.1%), drug and supply management (5.0%), and travelling (9.6%). The study found significant variations of time use across the managerial cadres as well as high weekly variations of time use impulsed mainly by a national vertical program. CONCLUSIONS District health managers in Ghana use substantial amounts of their working time in only few activities and vertical programs greatly influence their time use. Our findings suggest that efficiency gains are possible for district health managers. However, these are unlikely to be achieved without improvements within the general health system, as inefficiencies seem to be largely caused by external factors.
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Affiliation(s)
- Marc Bonenberger
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Moses Aikins
- School of Public Health, University of Ghana, Legon, Ghana
| | | | - Xavier Bosch-Capblanch
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kaspar Wyss
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Bosch-Capblanch X, Marceau C. Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence. J Glob Health 2014; 4:020403. [PMID: 25520793 PMCID: PMC4267084 DOI: 10.7189/jogh.04.020403] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aim To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Methods Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. Results The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi–component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming–up of CHW, micro–franchising or social franchising. On–site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers’ basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Conclusion Large, multi–faceted, iCCM programmes, with strong components of training, supervision, which included additional support of equipment and supplies, seemed to improve selected quality of care outcomes. However, current evaluation and reporting practices need to be revised in a new research agenda to address the methodological challenges of iCCM evaluations.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland
| | - Claudine Marceau
- Freelance consultant, attached to the Swiss Tropical and Public Health Institute, Basel, Switzerland
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Willis N, Hill S, Kaufman J, Lewin S, Kis-Rigo J, De Castro Freire SB, Bosch-Capblanch X, Glenton C, Lin V, Robinson P, Wiysonge CS. Erratum to: “Communicate to vaccinate”: the development of a taxonomy of communication interventions to improve routine childhood vaccination. BMC Int Health Hum Rights 2013. [PMCID: PMC3848268 DOI: 10.1186/1472-698x-13-37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Mshelia C, Huss R, Mirzoev T, Elsey H, Baine SO, Aikins M, Kamuzora P, Bosch-Capblanch X, Raven J, Wyss K, Green A, Martineau T. Can action research strengthen district health management and improve health workforce performance? A research protocol. BMJ Open 2013; 3:e003625. [PMID: 23996825 PMCID: PMC3758965 DOI: 10.1136/bmjopen-2013-003625] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/30/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The single biggest barrier for countries in sub-Saharan Africa (SSA) to scale up the necessary health services for addressing the three health-related Millennium Development Goals and achieving Universal Health Coverage is the lack of an adequate and well-performing health workforce. This deficit needs to be addressed both by training more new health personnel and by improving the performance of the existing and future health workforce. However, efforts have mostly been focused on training new staff and less on improving the performance of the existing health workforce. The purpose of this paper is to disseminate the protocol for the PERFORM project and reflect on the key challenges encountered during the development of this methodology and how they are being overcome. METHODS The overall aim of the PERFORM project is to identify ways of strengthening district management in order to address health workforce inadequacies by improving health workforce performance in SSA. The study will take place in three districts each in Ghana, Tanzania and Uganda using an action research approach. With the support of the country research teams, the district health management teams (DHMTs) will lead on planning, implementation, observation, reflection and redefinition of the activities in the study. Taking into account the national and local human resource (HR) and health systems (HS) policies and practices already in place, 'bundles' of HR/HS strategies that are feasible within the context and affordable within the districts' budget will be developed by the DHMTs to strengthen priority areas of health workforce performance. A comparative analysis of the findings from the three districts in each country will add new knowledge on the effects of these HR/HS bundles on DHMT management and workforce performance and the impact of an action research approach on improving the effectiveness of the DHMTs in implementing these interventions. DISCUSSION Different challenges were faced during the development of the methodology. These include the changing context in the study districts, competing with other projects and duties for the time of district managers, complexity of the study design, maintaining the anonymity and confidentiality of study participants as well as how to record the processes during the study. We also discuss how these challenges are being addressed. The dissemination of this research protocol is intended to generate interest in the PERFORM project and also stimulate discussion on the use of action research in complex studies such as this on strengthening district health management to improve health workforce performance.
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Affiliation(s)
- C Mshelia
- Nuffield Centre for International Health and Management, University of Leeds, Leeds, UK
| | - R Huss
- Nuffield Centre for International Health and Management, University of Leeds, Leeds, UK
| | - T Mirzoev
- Nuffield Centre for International Health and Management, University of Leeds, Leeds, UK
| | - H Elsey
- Nuffield Centre for International Health and Management, University of Leeds, Leeds, UK
| | - S O Baine
- School of Public Health, Makerere University, Kampala, Uganda
| | - M Aikins
- School of Public Health, University of Ghana, Legon, Ghana
| | - P Kamuzora
- Institute of Development Studies, University of Dar Es Salaam, Dar Es Salaam, United Republic of Tanzania
| | - X Bosch-Capblanch
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - J Raven
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Wyss
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - A Green
- Nuffield Centre for International Health and Management, University of Leeds, Leeds, UK
| | - T Martineau
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Patino-Lugo D, Lavis J, Perel P, Wu Y, Haines A, Ranson M, Panisset U, Bosch-Capblanch X, Brouwers M. P208 How Could Who Better Support National And Subnational Governments In Their Efforts To Adapt And Implement Global Recommendations And Decisions? A Systematic Analysis Of Health Systems Guidance And World Health Assembly Resolutions. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Willis N, Hill S, Kaufman J, Lewin S, Kis-Rigo J, De Castro Freire SB, Bosch-Capblanch X, Glenton C, Lin V, Robinson P, Wiysonge CS. "Communicate to vaccinate": the development of a taxonomy of communication interventions to improve routine childhood vaccination. BMC Int Health Hum Rights 2013; 13:23. [PMID: 23663327 PMCID: PMC3655915 DOI: 10.1186/1472-698x-13-23] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 05/05/2013] [Indexed: 11/25/2022]
Abstract
Background Vaccination is a cost-effective public health measure and is central to the Millennium Development Goal of reducing child mortality. However, childhood vaccination coverage remains sub-optimal in many settings. While communication is a key feature of vaccination programmes, we are not aware of any comprehensive approach to organising the broad range of communication interventions that can be delivered to parents and communities to improve vaccination coverage. Developing a classification system (taxonomy) organised into conceptually similar categories will aid in: understanding the relationships between different types of communication interventions; facilitating conceptual mapping of these interventions; clarifying the key purposes and features of interventions to aid implementation and evaluation; and identifying areas where evidence is strong and where there are gaps. This paper reports on the development of the ‘Communicate to vaccinate’ taxonomy. Methods The taxonomy was developed in two stages. Stage 1 included: 1) forming an advisory group; 2) searching for descriptions of interventions in trials (CENTRAL database) and general health literature (Medline); 3) developing a sampling strategy; 4) screening the search results; 5) developing a data extraction form; and 6) extracting intervention data. Stage 2 included: 1) grouping the interventions according to purpose; 2) holding deliberative forums in English and French with key vaccination stakeholders to gather feedback; 3) conducting a targeted search of grey literature to supplement the taxonomy; 4) finalising the taxonomy based on the input provided. Results The taxonomy includes seven main categories of communication interventions: inform or educate, remind or recall, teach skills, provide support, facilitate decision making, enable communication and enhance community ownership. These categories are broken down into 43 intervention types across three target groups: parents or soon-to-be-parents; communities, community members or volunteers; and health care providers. Conclusions Our taxonomy illuminates and organises this field and identifies the range of available communication interventions to increase routine childhood vaccination uptake. We have utilised a variety of data sources, capturing information from rigorous evaluations such as randomised trials as well as experiences and knowledge of practitioners and vaccination stakeholders. The taxonomy reflects current public health practice and can guide the future development of vaccination programmes.
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Affiliation(s)
- Natalie Willis
- Centre for Health Communication and Participation, Australian Institute for Primary Care & Ageing, La Trobe University, Bundoora, VIC 3086, Australia.
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Bosch-Capblanch X, Banerjee K, Burton A. Unvaccinated children in years of increasing coverage: how many and who are they? Evidence from 96 low- and middle-income countries. Trop Med Int Health 2012; 17:697-710. [PMID: 22943300 DOI: 10.1111/j.1365-3156.2012.02989.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE While childhood immunisation coverage levels have increased since the 70s, inequities in coverage between and within countries have been widely reported. Unvaccinated children remain undetected by routine monitoring systems and strikingly unreported. The objective of this study was to provide evidence on the magnitude of the problem and to describe predictors associated with non-vaccination. METHODS Two hundred and forty-one nationally representative household surveys in 96 countries were analysed. Proportions and changes in time of 'unvaccinated' (children having not received a single dose of vaccine), 'partially vaccinated' and 'fully vaccinated' children were estimated. Predictors of non-vaccination were explored. RESULTS The percentage of unvaccinated children was 9.9% across all surveys. 66 countries had more than one survey: 38 showed statistically significant reductions in the proportion of unvaccinated children between the first and last survey, 10 countries showed increases and the rest showed no significant changes. However, while 18 of the 38 countries also improved in terms of partially and fully vaccinated, in the other 20 the proportion of fully vaccinated decreased. The predictors more strongly associated with being unvaccinated were education of the caregiver, education of caregiver's partner, caregiver's tetanus toxoid (TT) status, wealth index and type of family member participation in decision-making when the child is ill. Multivariable logistic regression identified the TT status of the caregiver as the strongest predictors of unvaccinated children. Country-specific summaries were produced and sent to countries. CONCLUSION The number of unvaccinated children is not negligible and their proportion and the predictors of non-vaccination have to be drawn from specific surveys. Specific vaccine indicators cannot properly describe the performance of immunisation programmes in certain situations. National immunisation programmes and national and international immunisation stakeholders should also consider monitoring the proportion of unvaccinated children (i.e. those who have received no vaccines at all) and draw specific plans on the determinants of non-vaccination.
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Bosch-Capblanch X, Lavis JN, Lewin S, Atun R, Røttingen JA, Dröschel D, Beck L, Abalos E, El-Jardali F, Gilson L, Oliver S, Wyss K, Tugwell P, Kulier R, Pang T, Haines A. Guidance for evidence-informed policies about health systems: rationale for and challenges of guidance development. PLoS Med 2012; 9:e1001185. [PMID: 22412356 PMCID: PMC3295823 DOI: 10.1371/journal.pmed.1001185] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
In the first paper in a three-part series on health systems guidance, Xavier Bosch-Capblanch and colleagues examine how guidance is currently formulated in low- and middle-income countries, and the challenges to developing such guidance.
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Lavis JN, Røttingen JA, Bosch-Capblanch X, Atun R, El-Jardali F, Gilson L, Lewin S, Oliver S, Ongolo-Zogo P, Haines A. Guidance for evidence-informed policies about health systems: linking guidance development to policy development. PLoS Med 2012; 9:e1001186. [PMID: 22427746 PMCID: PMC3302830 DOI: 10.1371/journal.pmed.1001186] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In the second paper in a three-part series on health systems guidance, John Lavis and colleagues explore the challenge of linking guidance development and policy development at global and national levels.
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Affiliation(s)
- John N Lavis
- McMaster Health Forum, Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
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Lewin S, Hill S, Abdullahi LH, de Castro Freire SB, Bosch-Capblanch X, Glenton C, Hussey GD, Jones CM, Kaufman J, Lin V, Mahomed H, Rhoda L, Robinson P, Waggie Z, Willis N, Wiysonge CS. 'Communicate to vaccinate' (COMMVAC). building evidence for improving communication about childhood vaccinations in low- and middle-income countries: protocol for a programme of research. Implement Sci 2011; 6:125. [PMID: 22132930 PMCID: PMC3259054 DOI: 10.1186/1748-5908-6-125] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 12/02/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective provider-parent communication can improve childhood vaccination uptake and strengthen immunisation services in low- and middle-income countries (LMICs). Building capacity to improve communication strategies has been neglected. Rigorous research exists but is not readily found or applicable to LMICs, making it difficult for policy makers to use it to inform vaccination policies and practice.The aim of this project is to build research knowledge and capacity to use evidence-based strategies for improving communication about childhood vaccinations with parents and communities in LMICs. METHODS AND DESIGN This project is a mixed methods study with six sub-studies. In sub-study one, we will develop a systematic map of provider-parent communication interventions for childhood vaccinations by screening and extracting data from relevant literature. This map will inform sub-study two, in which we will develop a taxonomy of interventions to improve provider-parent communication around childhood vaccination. In sub-study three, the taxonomy will be populated with trial citations to create an evidence map, which will also identify how evidence is linked to communication barriers regarding vaccination. In the project's fourth sub-study, we will present the interventions map, taxonomy, and evidence map to international stakeholders to identify high-priority topics for systematic reviews of interventions to improve parent-provider communication for childhood vaccination. We will produce systematic reviews of the effects of high-priority interventions in the fifth sub-study. In the sixth and final sub-study of the project, evidence from the systematic reviews will be translated into accessible formats and messages for dissemination to LMICs. DISCUSSION This project combines evidence mapping, conceptual and taxonomy development, priority setting, systematic reviews, and knowledge transfer. It will build and share concepts, terms, evidence, and resources to aid the development of communication strategies for effective vaccination programmes in LMICs.
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Affiliation(s)
- Simon Lewin
- Norwegian Knowledge Centre for the Health Services, Olavs plass N-0130 Oslo, Norway.
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Bosch-Capblanch X, Kelly M, Garner P. Do existing research summaries on health systems match immunisation managers' needs in middle- and low-income countries? Analysis of GAVI health systems strengthening support. BMC Public Health 2011; 11:449. [PMID: 21651793 PMCID: PMC3125377 DOI: 10.1186/1471-2458-11-449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 06/08/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The GAVI Alliance was created in 2000 to increase access to vaccines. More recently, GAVI has supported evidence-based health systems strengthening to overcome barriers to vaccination. Our objectives were: to explore countries' priorities for health systems strengthening; to describe published research summaries for each priority area in relation to their number, quality and relevance; and to describe the use of national data from surveys in identifying barriers to immunisation. METHODS From 44 health systems strengthening proposals submitted to GAVI in 2007 and 2008, we analysed the topics identified, the coverage of these topics by existing systematic reviews and the use of nation-wide surveys with vaccination data to justify the needs identified in the proposals. RESULTS Thirty topics were identified and grouped into three thematic areas: health workforce (10 topics); organisation and management (14); and supply, distribution and maintenance (6). We found 51 potentially relevant systematic reviews, although for the topic that appeared most frequently in the proposals ('Health information systems') no review was identified. Thematic and geographic relevance were generally categorised as "high" in 33 (65%) and 25 (49%) reviews, respectively, but few reviews were categorised as "highly relevant for policy" (7 reviews, 14%). With regard to methodological quality, 14 reviews (27%) were categorised as "high".The number of topics that were addressed by at least one high quality systematic review was: seven of the 10 topics in the 'health workforce' thematic area; six of the 14 topics in the area of 'organisation and management'; and none of the topics in the thematic area of 'supply, distribution and maintenance'. Only twelve of the 39 countries with available national surveys referred to them in their proposals. CONCLUSION Relevant, high quality research summaries were found for few of the topics identified by managers. Few proposals used national surveys evidence to identify barriers to vaccination. Researchers generating or adapting evidence about health systems need to be more responsive to managers' needs. Use of available evidence from local or national surveys should be strongly encouraged.
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Bosch-Capblanch X. Harmonisation of variables names prior to conducting statistical analyses with multiple datasets: an automated approach. BMC Med Inform Decis Mak 2011; 11:33. [PMID: 21595905 PMCID: PMC3123542 DOI: 10.1186/1472-6947-11-33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 05/19/2011] [Indexed: 12/02/2022] Open
Abstract
Background Data requirements by governments, donors and the international community to measure health and development achievements have increased in the last decade. Datasets produced in surveys conducted in several countries and years are often combined to analyse time trends and geographical patterns of demographic and health related indicators. However, since not all datasets have the same structure, variables definitions and codes, they have to be harmonised prior to submitting them to the statistical analyses. Manually searching, renaming and recoding variables are extremely tedious and prone to errors tasks, overall when the number of datasets and variables are large. This article presents an automated approach to harmonise variables names across several datasets, which optimises the search of variables, minimises manual inputs and reduces the risk of error. Results Three consecutive algorithms are applied iteratively to search for each variable of interest for the analyses in all datasets. The first search (A) captures particular cases that could not be solved in an automated way in the search iterations; the second search (B) is run if search A produced no hits and identifies variables the labels of which contain certain key terms defined by the user. If this search produces no hits, a third one (C) is run to retrieve variables which have been identified in other surveys, as an illustration. For each variable of interest, the outputs of these engines can be (O1) a single best matching variable is found, (O2) more than one matching variable is found or (O3) not matching variables are found. Output O2 is solved by user judgement. Examples using four variables are presented showing that the searches have a 100% sensitivity and specificity after a second iteration. Conclusion Efficient and tested automated algorithms should be used to support the harmonisation process needed to analyse multiple datasets. This is especially relevant when the numbers of datasets or variables to be included are large.
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Bosch-Capblanch X, Ronveaux O, Doyle V, Remedios V, Bchir A. Accuracy and quality of immunization information systems in forty-one low income countries. Trop Med Int Health 2009; 14:2-10. [DOI: 10.1111/j.1365-3156.2008.02181.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bosch-Capblanch X, Abba K, Prictor M, Garner P. Contracts between patients and healthcare practitioners for improving patients' adherence to treatment, prevention and health promotion activities. Cochrane Database Syst Rev 2007; 2007:CD004808. [PMID: 17443556 PMCID: PMC6464838 DOI: 10.1002/14651858.cd004808.pub3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Contracts are a verbal or written agreement that a patient makes with themselves, with healthcare practitioners, or with carers, where participants commit to a set of behaviours related to the care of a patient. Contracts aim to improve the patients' adherence to treatment or health promotion programmes. OBJECTIVES To assess the effects of contracts between patients and healthcare practitioners on patients' adherence to treatment, prevention and health promotion activities, the stated health or behaviour aims in the contract, patient satisfaction or other relevant outcomes, including health practitioner behaviour and views, health status, reported harms, costs, or denial of treatment as a result of the contract. SEARCH STRATEGY We searched: the Cochrane Consumers and Communication Review Group's Specialised Register (in May 2004); the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library 2004, issue 1); MEDLINE 1966 to May 2004); EMBASE (1980 to May 2004); PsycINFO (1966 to May 2004); CINAHL (1982 to May 2004); Dissertation Abstracts. A: Humanities and Social Sciences (1966 to May 2004); Sociological Abstracts (1963 to May 2004); UK National Research Register (2000 to May 2004); and C2-SPECTR, Campbell Collaboration (1950 to May 2004). SELECTION CRITERIA We included randomised controlled trials comparing the effects of contracts between healthcare practitioners and patients or their carers on patient adherence, applied to diagnostic procedures, therapeutic regimens or any health promotion or illness prevention initiative for patients. Contracts had to specify at least one activity to be observed and a commitment of adherence to it. We included trials comparing contracts with routine care or any other intervention. DATA COLLECTION AND ANALYSIS Selection and quality assessment of trials were conducted independently by two review authors; single data extraction was checked by a statistician. We present the data as a narrative summary, given the wide range of interventions, participants, settings and outcomes, grouped by the health problem being addressed. MAIN RESULTS We included thirty trials, all conducted in high income countries, involving 4691 participants. Median sample size per group was 21. We examined the quality of each trial against eight standard criteria, and all trials were inadequate in relation to three or more of these standards. Trials evaluated contracts in addiction (10 trials), hypertension (4 trials), weight control (3 trials) and a variety of other areas (13 trials). Sixteen trials reported at least one outcome that showed statistically significant differences favouring the contracts group, five trials reported at least one outcome that showed differences favouring the control group and 26 trials reported at least one outcome without differences between groups. Effects on adherence were not detected when measured over longer periods. AUTHORS' CONCLUSIONS There is limited evidence that contracts can potentially contribute to improving adherence, but there is insufficient evidence from large, good quality studies to routinely recommend contracts for improving adherence to treatment or preventive health regimens.
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Affiliation(s)
- X Bosch-Capblanch
- International Health Research Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK L35QA.
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Bosch-Capblanch X, Garner P. Supervision outreach visits to improve the quality of primary health care in low- and middle-income countries. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2007. [DOI: 10.1002/14651858.cd006413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
BACKGROUND Lay health workers (LHWs) are widely used to provide care for a broad range of health issues. However, little is known about the effectiveness of LHW interventions. OBJECTIVES To assess the effects of LHW interventions in primary and community health care on health care behaviours, patients' health and wellbeing, and patients' satisfaction with care. SEARCH STRATEGY We searched the Cochrane Effective Practice and Organisation of Care and Consumers and Communication specialised registers (to August 2001); the Cochrane Central Register of Controlled Trials (to August 2001); MEDLINE (1966- August 2001); EMBASE (1966-August 2001); Science Citations (to August 2001); CINAHL (1966-June 2001); Healthstar (1975-2000); AMED (1966-August 2001); the Leeds Health Education Effectiveness Database and the reference lists of articles. SELECTION CRITERIA Randomised controlled trials of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to promote health, manage illness or provide support to patients. A 'lay health worker' was defined as any health worker carrying out functions related to health care delivery; trained in some way in the context of the intervention; and having no formal professional or paraprofessional certificated or degreed tertiary education. There were no restrictions on the types of consumers. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data onto a standard form and assessed study quality. Studies that compared broadly similar types of interventions were grouped together. Where feasible, the results of included studies were combined and an estimate of effect obtained. MAIN RESULTS Forty three studies met the inclusion criteria, involving more than 210,110 consumers. These showed considerable diversity in the targeted health issue and the aims, content and outcomes of interventions. Most were conducted in high income countries (n=35), but nearly half of these focused on low income and minority populations (n=15). Study diversity limited meta-analysis to outcomes for five subgroups (n=15 studies) (LHW interventions to promote the uptake of breast cancer screening, immunisation and breastfeeding promotion [before two weeks and between two weeks and six months post partum] and to improve diagnosis and treatment for selected infectious diseases). Promising benefits in comparison with usual care were shown for LHW interventions to promote immunisation uptake in children and adults (RR=1.30 [95% CI 1.14, 1.48] p=0.0001) and LHW interventions to improve outcomes for selected infectious diseases (RR=0.74 [95% CI 0.58, 0.93) p=0.01). LHWs also appear promising for breastfeeding promotion. They appear to have a small effect in promoting breast cancer screening uptake when compared with usual care. For the remaining subgroups (n=29 studies), the outcomes were too diverse to allow statistical pooling. We can therefore draw no general conclusions on the effectiveness of these subgroups of interventions. AUTHORS' CONCLUSIONS LHWs show promising benefits in promoting immunisation uptake and improving outcomes for acute respiratory infections and malaria, when compared to usual care. For other health issues, evidence is insufficient to justify recommendations for policy and practice. There is also insufficient evidence to assess which LHW training or intervention strategies are likely to be most effective. Further research is needed in these areas.
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Affiliation(s)
- S A Lewin
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK, WC1E 7HT.
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Alonzo González M, Menéndez C, Font F, Kahigwa E, Kimario J, Mshinda H, Tanner M, Bosch-Capblanch X, Alonso PL. Cost-effectiveness of iron supplementation and malaria chemoprophylaxis in the prevention of anaemia and malaria among Tanzanian infants. Bull World Health Organ 2000; 78:97-107. [PMID: 10686744 PMCID: PMC2560593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Prerequisites for effective interventions against severe anaemia and malaria among infants are economic evaluations to aid the setting of priorities and the making of health policy. In the present study we analysed the cost and effectiveness of three control strategies hypothetically delivered through the Expanded Programme on Immunization (EPI). For the prevention of severe anaemia and from the perspective of the health provider, the cost-effectiveness ratios were, respectively, US$ 8, US$ 9, and US$ 21 per disability-adjusted life year (DALY) for malaria chemoprophylaxis with Deltaprim (a combination of 3.125 mg pyrimethamine and 25 mg dapsone) + iron, Deltaprim alone, or iron supplementation alone. For malaria prevention, Deltaprim + iron cost US$ 9.7 per DALY and Deltaprim alone cost US$ 10.2 per DALY. From a sociocultural perspective the cost-effectiveness ratios ranged from US$ 9 to US$ 26 for severe anaemia prevention and from US$ 11 to US$ 12 for the prevention of clinical malaria. These ratios were highly cost-effective, as defined by the World Bank's proposed threshold of less than US$ 25 per DALY for comparative assessments. Furthermore, all the preventive interventions were less costly than the current malaria and anaemia control strategies that rely on clinical case management. This economic analysis supports the inclusion of both malaria chemoprophylaxis and iron supplementation delivered through EPI as part of the control strategies for these major killers of infants in parts of sub-Saharan Africa.
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Affiliation(s)
- M Alonzo González
- Epidemiology and Biostatistics Unit, Hospital Clinic, Barcelona, Spain.
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Filella X, Alcover J, Quintó L, Molina R, Bosch-Capblanch X, Carretero P, Ballesta AM. Evaluation of a multivariate prostate-specific antigen and percentage of free prostate-specific antigen logistic regression model in the diagnosis of prostate cancer. Tumour Biol 1999; 20:312-8. [PMID: 10567877 DOI: 10.1159/000030095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The use of prostate-specific antigen (PSA) in the diagnosis of prostate cancer is controversial due to false-positive results caused by benign prostatic hyperplasia. Several groups have suggested the usefulness of the percentage of free PSA (%fPSA) in patients with PSA levels between 4 and 10 microg/l. Based on previously obtained results, biopsy is carried out in our hospital if the PSA is greater than 10 microg/l or if the %fPSA is lower than 20% and PSA is between 4-10 microg/l. In this study, we have compared these results with those obtained with a logistic regression model based on the determination of PSA and %fPSA. The diagnostic efficacy of the logistic regression model is greater than that of the currently used model. The posterior construction of a nomogram based on the data obtained greatly facilitates the application of the logistic regression model.
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Affiliation(s)
- X Filella
- Department of Clinical Biochemistry (Unit for Cancer Research), 'Institut d'Investigacions Biomèdiques August Pi i Sunyer', Hospital Clínic, Barcelona, Spain.
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Bosch-Capblanch X, Loscertales MP, Memndigide A, Santias XC. The 'handy tablets delivery device'. Trop Doct 1999; 29:31-2. [PMID: 10418278 DOI: 10.1177/004947559902900111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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